Healthcare Provider Details

I. General information

NPI: 1750877627
Provider Name (Legal Business Name): MICHIGAN SURGERY SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22731 NEWMAN ST STE 100B
DEARBORN MI
48124
US

IV. Provider business mailing address

11012 E 13 MILE RD STE 200
WARREN MI
48093-2547
US

V. Phone/Fax

Practice location:
  • Phone: 313-791-0616
  • Fax: 313-791-0632
Mailing address:
  • Phone: 586-558-9705
  • Fax: 586-558-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHELE L KUDLOR
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 586-558-9705