Healthcare Provider Details

I. General information

NPI: 1164411278
Provider Name (Legal Business Name): MICHIGAN SURGERY SPECIALISTS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 E 13 MILE RD STE 200
WARREN MI
48093
US

IV. Provider business mailing address

31201 CHICAGO RD S STE C302
WARREN MI
48093-5553
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-8890
  • Fax: 586-573-2706
Mailing address:
  • Phone: 586-558-9705
  • Fax: 586-558-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELE L KUDLOR
Title or Position: BILLING MANAGER
Credential:
Phone: 586-558-9705