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General NPI Number Information
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NPI Number | 1508658907
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Entity Type | Organization
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Legal Business Name | QASAWA PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 1080 KIRTS BLVD STE 700
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City | TROY
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State | MI
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Zip | 48084-4853
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Country | US
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Telephone | 248-362-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 KIRTS BLVD STE 700
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City | TROY
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State | MI
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Zip | 48084-4853
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN QASAWA
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Credential | DO
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Telephone | 586-630-7699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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