Healthcare Provider Details

I. General information

NPI: 1295223998
Provider Name (Legal Business Name): LIMB PRESERVATION GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33376 DEQUINDRE RD
STERLING HEIGHTS MI
48310-5966
US

IV. Provider business mailing address

869 LAKE SHORE RD
GROSSE POINTE SHORES MI
48236-1274
US

V. Phone/Fax

Practice location:
  • Phone: 586-515-0608
  • Fax:
Mailing address:
  • Phone: 248-421-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN J. MAYRAND
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 248-421-5420