Healthcare Provider Details

I. General information

NPI: 1295786291
Provider Name (Legal Business Name): PLASTIC SURGERY OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2006
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29877 TELEGRAPH RD SUITE 107
SOUTHFIELD MI
48034-1332
US

IV. Provider business mailing address

29877 TELEGRAPH RD SUITE 107
SOUTHFIELD MI
48034-1332
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 TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MICHAEL LOFMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 248-990-4715