Organization
SPECIALIZED SURGEONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY STACEY (OFFICE MANAGER)
(248) 888-8383
Entity
Organization
Contact information
Practice address
33111 W. SEVEN MILE RD., LIVONIA,, MI 48152
(248) 888-8383
(348) 888-0834
Mailing address
33111 W. SEVEN MILE RD., LIVONIA,, MI 48152
(248) 888-8383
(348) 888-0834
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OH20333
BLUE CROSS BLUE SHIELD OF MI
MI
Enumeration date
07/28/2006
Last updated
11/11/2008
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