MEDICARE: MICHIGAN OMS P C

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2901020355	OTHER	MI	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	970F31085	OTHER	MI	GROUP NUMBER BCBSM
8	NB015573	OTHER	MI	STATE LICENSE NUMBER
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801906458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN OMS P C

Provider Business Mailing Address
First Line	:	6022 W MAPLE RD STE 405
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4408
Country	:	US
Telephone Number	:	248-855-2006
Fax Number	:	248-855-0571

Provider Business Practice Location Address
First Line	:	6022 W MAPLE RD STE 405
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4408
Country	:	US
Telephone Number	:	248-855-2006
Fax Number	:	248-855-0571

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NICHOLAS J BOURNIAS
Credential	:	DDS
Telephone Number	:	586-228-9070

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/17/2024

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Directions to “MICHIGAN OMS P C ” Practice Location

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