=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669658563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER PLASTIC SURGERY,P.C.,F.A.C.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2008
-----------------------------------------------------
Last Update Date | 01/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9450 S SAGINAW RD STE F
-----------------------------------------------------
City | GRAND BLANC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48439-8206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-606-8200
-----------------------------------------------------
Fax | 810-606-8282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1232
-----------------------------------------------------
City | GRAND BLANC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48480-3232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-606-8200
-----------------------------------------------------
Fax | 810-606-8282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PLASTIC SURGEON WITH HAND SPECIALTY
-----------------------------------------------------
Name | DR. RAMOTSUMI M MAKHENE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 810-606-8200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2082S0105X
-----------------------------------------------------
Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------