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General NPI Number Information
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NPI Number | 1811892185
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Entity Type | Organization
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Legal Business Name | KOUMANIS DIET HEALTH CLINIC OF MICHIGAN, PLLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 2243 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48092-5644
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Country | US
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Telephone | 518-203-2593
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Fax |
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Provider Business Mailing Address
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Address Line | 2243 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48092-5644
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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 | DIMITRI J KOUMANIS
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Credential |
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Telephone | 518-203-2593
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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 | NULL
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