Executive Plastic Surgery, PLLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

4301098160 Issued in MI

Legal business name

EXECUTIVE PLASTIC SURGERY, PLLC

Practice address

43940 Woodward Ave Ste 100
Bloomfield Hills, MI 48302-5025

Phone

(734) 419-1615

Fax

(248) 934-2185

NPI assigned

Oct 27, 2014

Last updated

Mar 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Shaher W Khan, MDNPI 1871756007

Title

Ceo

Phone

(734) 419-1615

Specialties & licenses 1

Addresses

Other names 1

• Crescent Plastic Surgery, PLLC Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shaher W Khan, MD

  • Plastic Surgery Physician
  • Bloomfield Hills, MI
  • NPI 1871756007
  Authorized official Same address or phone

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

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1649675174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43940 WOODWARD AVE STE 100",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025025",
            "telephone_number": "734-419-1615",
            "fax_number": "248-934-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43940 WOODWARD AVE STE 100",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483025025",
            "telephone_number": "734-419-1615",
            "fax_number": "248-934-2185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE PLASTIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-27",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SHAHER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "734-419-1615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MI",
            "license": "4301098160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crescent Plastic Surgery, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Plastic Surgery Physician in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Plastic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.