Healthcare Provider Details

I. General information

NPI: 1174776033
Provider Name (Legal Business Name): PLASTIC SURGERY AFFILIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30603 SOUTHFIELD RD
SOUTHFIELD MI
48076-7729
US

IV. Provider business mailing address

30603 SOUTHFIELD RD
SOUTHFIELD MI
48076-7729
US

V. Phone/Fax

Practice location:
  • Phone: 248-355-9911
  • Fax: 248-355-9961
Mailing address:
  • Phone: 248-355-9911
  • Fax: 248-355-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number032600
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number032600
License Number StateMI

VIII. Authorized Official

Name: HASHIM M. ALANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-355-9911