Derosa Plastic Surgery, PLLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

5101017043 Issued in MI

Legal business name

DEROSA PLASTIC SURGERY, PLLC

Practice address

22401 Foster Winter Dr
Southfield, MI 48075-3724

Phone

(248) 688-7597

Fax

(248) 498-6060

NPI assigned

Dec 30, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Amy P Derosa, DO

Title

Owner

Phone

(248) 688-7597

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1419897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1144618075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22401 FOSTER WINTER DR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753724",
            "telephone_number": "248-688-7597",
            "fax_number": "248-498-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22401 FOSTER WINTER DR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753724",
            "telephone_number": "248-688-7597",
            "fax_number": "248-498-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEROSA PLASTIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-30",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "DEROSA",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-688-7597",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "5101017043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7789986",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Southfield, MI by specialty
• Plastic and Reconstructive Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.