=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366231813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSMETIC AND LASER CENTER OF MI PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2025
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5084 VILLA LINDE PKWY STE 6
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-422-9885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1230 S LINDEN RD STE 3A
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-3459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-422-9885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | FAISAL MAWRI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 810-422-9885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------