Healthcare Provider Details

I. General information

NPI: 1669658563
Provider Name (Legal Business Name): PREMIER PLASTIC SURGERY,P.C.,F.A.C.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 S SAGINAW RD STE F
GRAND BLANC MI
48439-8206
US

IV. Provider business mailing address

PO BOX 1232
GRAND BLANC MI
48480-3232
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-8200
  • Fax: 810-606-8282
Mailing address:
  • Phone: 810-606-8200
  • Fax: 810-606-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMOTSUMI M MAKHENE
Title or Position: PLASTIC SURGEON WITH HAND SPECIALTY
Credential: MD
Phone: 810-606-8200