Organization
MICHIGAN COSMETIC & RECONSTRUCTIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAM H AWADA MD (OWNER)
(248) 540-1900
Entity
Organization
Contact information
Practice address
30603 SOUTHFIELD RD, SOUTHFIELD, MI 48076-7729
(248) 540-1900
(248) 767-8706
Mailing address
30603 SOUTHFIELD RD, SOUTHFIELD, MI 48076-7729
(248) 540-1900
(248) 767-8706
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
4301082433
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301082433
STATE LICENSE
MA
Enumeration date
03/07/2007
Last updated
04/20/2008
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