Organization
PLASTIC SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUDARSHAN R REDDY MD FACS (SOLE OWNER OF FACILITY)
(586) 263-6050
Entity
Organization
Contact information
Practice address
16100 19 MILE RD, SUITE 100, CLINTON TOWNSHIP, MI 48038-1148
(586) 263-9657
(586) 263-0436
Mailing address
16100 19 MILE RD, SUITE 100, CLINTON TOWNSHIP, MI 48038-1148
(586) 263-9657
(586) 263-0436
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E01483
BCBS
MI
01
—
Z40007538
RAILROAD MEDICARE
MI
Enumeration date
11/11/2005
Last updated
08/22/2020
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