Healthcare Provider Details

I. General information

NPI: 1093899767
Provider Name (Legal Business Name): PLASTIC SURGERY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LYON ST NW SUITE 700
GRAND RAPIDS MI
49503-2208
US

IV. Provider business mailing address

220 LYON ST NW SUITE 700
GRAND RAPIDS MI
49503-2208
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-4500
  • Fax: 616-451-9077
Mailing address:
  • Phone: 616-451-4500
  • Fax: 616-451-9077

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: MRS. DEBORAH HOUGHTON-REDDING
Title or Position: MANAGER
Credential:
Phone: 616-451-4500