Organization
NORTHEAST SURGICAL SPECIALISTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER DAVID KOWYNIA M.D. (OWNER)
(586) 212-0606
Entity
Organization
Contact information
Practice address
43211 DALCOMA DR, SUITE 4, CLINTON TWP, MI 48038-6309
(586) 286-8800
(586) 286-8068
Mailing address
43211 DALCOMA DR, SUIT 4, CLINTON TWP, MI 48038-6309
(586) 286-8800
(586) 286-8068
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301051240
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02 0502600
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
05
—
102873117
—
MI
Enumeration date
04/25/2008
Last updated
03/21/2013
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