MEDICARE: IMAGE BY DESIGN 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	:	1265600464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGE BY DESIGN PLASTIC SURGERY PLLC

Provider Business Mailing Address
First Line	:	20905 E 12 MILE RD
Second Line	:	STE 300
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6501
Country	:	US
Telephone Number	:	586-776-3223
Fax Number	:	586-776-6670

Provider Business Practice Location Address
First Line	:	20905 E 12 MILE RD
Second Line	:	STE 300
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6501
Country	:	US
Telephone Number	:	586-776-3223
Fax Number	:	586-776-6670

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	MELEK R KAYSER
Credential	:	MD
Telephone Number	:	586-776-3223

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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