Healthcare Provider Details

I. General information

NPI: 1134278401
Provider Name (Legal Business Name): RENAISSANCE PLASTIC SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/21/2022
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E BIG BEAVER RD
TROY MI
48083
US

IV. Provider business mailing address

85 E BIG BEAVER RD
TROY MI
48083
US

V. Phone/Fax

Practice location:
  • Phone: 586-779-3030
  • Fax: 586-779-6733
Mailing address:
  • Phone: 586-779-3030
  • Fax: 586-779-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM A STEFANI
Title or Position: OWNER
Credential:
Phone: 586-779-3030