Healthcare Provider Details

I. General information

NPI: 1023203791
Provider Name (Legal Business Name): PLASTIC SURGERY CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE NUMBER 202
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

18181 OAKWOOD BLVD SUITE NUMBER 202
DEARBORN MI
48124-5032
US

V. Phone/Fax

Practice location:
  • Phone: 313-277-0500
  • Fax: 313-277-1760
Mailing address:
  • Phone: 313-277-0500
  • Fax: 313-277-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SATISH C VYAS
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 313-277-0500