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NPI Code Detail

MEDICARE: PREMIER HEAD AND NECK SURGERY PC

MEDICARE: PREMIER HEAD AND NECK SURGERY PC
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
1207YX0007XPlastic Surgery within the Head & Neck (Otolaryngology) Physician

General Provider Information

NPI Number : 1578253167
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER HEAD AND NECK SURGERY PC
Provider Business Mailing Address
First Line : 5556 ORMOND RD
Second Line :
City : WHITE LAKE
State : MI
Zip : 48383-1261
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5040 VILLA LINDE PKWY STE A
Second Line :
City : FLINT
State : MI
Zip : 48532-3445
Country : US
Telephone Number : 810-399-9931
Fax Number : 810-382-2022
Authorized Official
Title or Position : OWNER
Name : TAMER GHANEM
Credential : MD
Telephone Number : 947-957-8315
Provider Enumeration Date : 05/09/2023
Last Update Date : 04/21/2026

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