Healthcare Provider Details

I. General information

NPI: 1053771857
Provider Name (Legal Business Name): JANINEH PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 ROCHESTER RD
TROY MI
48085-3374
US

IV. Provider business mailing address

5600 ROCHESTER RD
TROY MI
48085-3374
US

V. Phone/Fax

Practice location:
  • Phone: 248-212-0116
  • Fax:
Mailing address:
  • Phone: 248-212-0116
  • Fax:

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: INAD JANINEH
Title or Position: OWNER
Credential:
Phone: 810-627-9606