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General NPI Number Information
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NPI Number | 1538458930
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Entity Type | Organization
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Legal Business Name | B AND S SERVICE CORP PC
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 39500 W. 10 MILE ROAD SUITE 105
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City | NOVI
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State | MI
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Zip | 48375-2947
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Country | US
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Telephone | 248-478-7733
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Fax | 248-478-3533
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Provider Business Mailing Address
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Address Line | 39500 W. 10 MILE ROAD SUITE 105
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City | NOVI
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State | MI
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Zip | 48375-2947
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Country | US
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Telephone | 248-478-7733
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Fax | 248-478-3533
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT I BOORSTEIN
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Credential | DO
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Telephone | 248-478-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | RB007073
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License Number State | MI
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