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General NPI Number Information
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NPI Number | 1578445698
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Entity Type | Organization
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Legal Business Name | WEST MAPLE PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 5807 W MAPLE RD STE 177
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4483
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Country | US
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Telephone | 248-865-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 5807 W MAPLE RD STE 177
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4483
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Country | US
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Telephone | 248-865-6400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY DESANO II
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Credential | DO
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Telephone | 248-797-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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