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NPI Code Detail

MEDICARE: DETROIT SURGICAL SPECIALIST, P.C.

MEDICARE: DETROIT SURGICAL SPECIALIST, 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
1174400000XSpecialistAN066667MI

General Provider Information

NPI Number : 1871694083
Entity Type Code : Organization
Provider Name (Legal Business Name) : DETROIT SURGICAL SPECIALIST, P.C.
Provider Business Mailing Address
First Line : 135 S PROSPECT ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-7914
Country : US
Telephone Number : 734-547-4900
Fax Number : 734-547-4901
Provider Business Practice Location Address
First Line : 135 S PROSPECT ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-7914
Country : US
Telephone Number : 734-547-4900
Fax Number : 734-547-4901
Authorized Official
Title or Position : PRESIDENT
Name : DR. ANDRE R NUNN
Credential : M.D.
Telephone Number : 313-547-4900
Provider Enumeration Date : 09/26/2006
Last Update Date : 06/29/2016

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Directions to “DETROIT SURGICAL SPECIALIST, P.C. ” Practice Location

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