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General NPI Number Information
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NPI Number | 1356563654
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR PLASTIC SURGERY OF NORTHERN MICHIGAN
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 4110 COPPER RIDGE DR SUITE 242
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-6722
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Country | US
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Telephone | 231-929-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 4110 COPPER RIDGE DR SUITE 242
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-6722
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Country | US
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Telephone | 231-929-7700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER JEFFRIES
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Credential |
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Telephone | 231-929-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301054838
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License Number State | MI
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