Organization
DEROSA PLASTIC SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY P DEROSA DO (OWNER)
(248) 688-7597
Entity
Organization
Contact information
Practice address
22401 FOSTER WINTER DR, SOUTHFIELD, MI 48075-3724
(248) 688-7597
(248) 498-6060
Mailing address
22401 FOSTER WINTER DR, SOUTHFIELD, MI 48075-3724
(248) 688-7597
(248) 498-6060
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
5101017043
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7789986
—
MI
Enumeration date
12/30/2014
Last updated
06/22/2015
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