MEDICARE: ATISHA PLASTIC SURGERY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1164370680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATISHA PLASTIC SURGERY, PLLC

Provider Business Mailing Address
First Line	:	1921 LONE PINE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-2522
Country	:	US
Telephone Number	:	248-232-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 WILSHIRE DR STE 100
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-1526
Country	:	US
Telephone Number	:	248-232-0700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DUNYA MARY ATISHA
Credential	:	MD, FACS
Telephone Number	:	248-514-7724

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/24/2026

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