Michigan Cosmetic & Reconstructive

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

4301082433 Issued in MI

Legal business name

MICHIGAN COSMETIC & RECONSTRUCTIVE

Practice address

30603 Southfield Rd
Southfield, MI 48076-7729

Phone

(248) 540-1900

Fax

(248) 767-8706

NPI assigned

Mar 7, 2007

Last updated

Apr 20, 2008By 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

Mariam H Awada, MDNPI 1114979515

Title

Owner

Phone

(248) 540-1900

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Mariam Awada, M.D.

  • Plastic Surgery Physician
  • Southfield, MI
  • NPI 1114979515
  NPD (past) Authorized official

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1699805556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30603 SOUTHFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480767729",
            "telephone_number": "248-540-1900",
            "fax_number": "248-767-8706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30603 SOUTHFIELD RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480767729",
            "telephone_number": "248-540-1900",
            "fax_number": "248-767-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN COSMETIC & RECONSTRUCTIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "AWADA",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-540-1900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "MI",
            "license": "4301082433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4301082433",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Michigan Diagnostic, LLC

• Plastic Surgery Physician in Southfield, MI
• Providers in Southfield, 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 Apr 20, 2008; 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.