NPIMap

Organization Active NPI

Advanced Plastic Surgery, PC

  • Plastic Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1255003893
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
ADVANCED PLASTIC SURGERY, PC
Practice address
3855 Burton St SE Ste a
Grand Rapids, MI 49546-6147
Phone
(616) 323-3102
Fax
(616) 323-3061
NPI assigned
Oct 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Authorized official

Name
Ewa D Komorowska-Timek, MDNPI 1710996319
Title
Physician Owner
Phone
(616) 323-3102

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

3855 Burton St SE Ste a
Grand Rapids, MI 49546-6147

Mailing address

3855 Burton St SE Ste a
Grand Rapids, MI 49546-6147
Phone (616) 323-3102

National Provider Directory

National Provider Directory
Tax ID family
Advanced Plastic Surgery PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1255003893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 BURTON ST SE STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466147",
            "telephone_number": "616-323-3102",
            "fax_number": "616-323-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 BURTON ST SE STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466147",
            "telephone_number": "616-323-3102",
            "fax_number": "616-323-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PLASTIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "KOMOROWSKA-TIMEK",
        "authorized_official_first_name": "EWA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "616-323-3102",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.