Healthcare Provider Details

I. General information

NPI: 1740533892
Provider Name (Legal Business Name): FACIAL SURGERY INSTITUTE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 LINCOLN AVE SUITE #4
MARQUETTE MI
49855-2679
US

IV. Provider business mailing address

1029 LINCOLN AVE SUITE #4
MARQUETTE MI
49855-2679
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-5959
  • Fax:
Mailing address:
  • Phone: 906-225-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: FRANK FARBOD
Title or Position: MEDICAL DIRECTOR
Credential: MD,DMD,FACS,FRCS
Phone: 906-225-5959