| NPI | 1144618075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY P DEROSA Owner 248-688-7597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 5101017043) |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2015-06-22 |