Healthcare Provider Details

I. General information

NPI: 1245394576
Provider Name (Legal Business Name): HAND & PLASTIC SURGERY CENTRE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHERRY ST SE SUITE 302
GRAND RAPIDS MI
49503-4607
US

IV. Provider business mailing address

245 CHERRY ST SE SUITE 302
GRAND RAPIDS MI
49503-4607
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-4131
  • Fax: 616-459-6030
Mailing address:
  • Phone: 616-459-4131
  • Fax: 616-459-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: KATHY ALLEN-STOUFFER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 616-459-4131