Michigan Surgery Specialists, P.C.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

MICHIGAN SURGERY SPECIALISTS, P.C.

Doing business as

Life Scan Imaging of Michigan

Practice address

11012 Thirteen Mile Road
Suite 111
Warren, MI 48093

Phone

(586) 558-8470

Fax

(586) 558-8481

NPI assigned

Aug 19, 2005

Reactivated

Nov 17, 2008

Last updated

Mar 26, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

MICHIGAN SURGERY SPECIALISTS, P.C.As reported in NPPES

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

Authorized official

Name

Michele Kudlor

Title

Billing Manager

Phone

(586) 459-5592

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Life Scan Imaging of Michigan Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Michigan Surgery Specialists, P.C.

  • Surgery Physician
  • Warren, MI
  • NPI 1184828451

  O20040302001010

  Same enrollment

Part of

Burke Edwar

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Michigan Surgery Specialists, P.C.

  • Surgery Physician
  • Warren, MI
  • NPI 1184828451
  NPPES parent name

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1316939952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31201 CHICAGO RD S STE C302",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480935553",
            "telephone_number": "586-582-0864",
            "fax_number": "586-582-0964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11012 THIRTEEN MILE ROAD",
            "address_2": "SUITE 111",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48093",
            "telephone_number": "586-558-8470",
            "fax_number": "586-558-8481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN SURGERY SPECIALISTS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MICHIGAN SURGERY SPECIALISTS, P.C.",
        "enumeration_date": "2005-08-19",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "deactivation_date": "2008-07-10",
        "reactivation_date": "2008-11-17",
        "status": "A",
        "authorized_official_last_name": "KUDLOR",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "586-459-5592"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301046061",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2471C3401X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Computed Tomography",
            "state": "MI",
            "license": "4301046061",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN NUMBER",
            "identifier": "300E017160",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RADIATION MACHINE REGISTR",
            "identifier": "53317",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Scan Imaging of Michigan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Diagnostic Radiology Physician in Warren, MI
• Providers in Warren, MI by specialty
• Diagnostic Radiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.