Healthcare Provider Details

I. General information

NPI: 1508658907
Provider Name (Legal Business Name): QASAWA PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 KIRTS BLVD STE 700
TROY MI
48084-4853
US

IV. Provider business mailing address

1080 KIRTS BLVD STE 700
TROY MI
48084-4853
US

V. Phone/Fax

Practice location:
  • Phone: 248-362-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN QASAWA
Title or Position: OWNER
Credential: DO
Phone: 586-630-7699