Advanced Plastic Surgery, PC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

4301095374 Issued in MI

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

Jun 5, 2013

Organization subpart

No

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

Authorized official

Name

Ewa D Komorowska-Timek, M.D.NPI 1710996319

Title

Owner

Phone

(616) 206-1040

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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.

• Advanced Plastic Surgery, PC

  • Plastic Surgery Physician
  • Grand Rapids, MI
  • NPI 1255003893
  NPD tax ID
• Advanced Plastic Surgery, PC

  • Ambulatory Surgical Clinic/Center
  • Grand Rapids, MI
  • NPI 1497425508
  NPD tax ID

Locations

Practitioners 2

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

• Ewa D Komorowska-Timek, MD

  • Plastic and Reconstructive Surgery Physician
  • Grand Rapids, MI
  • NPI 1710996319
  Medicare reassignment NPD Authorized official
• David D. Sova, D.O.

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1952359895
  NPD (past)

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

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738886400000",
    "number": "1730527326",
    "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": "2013-06-05",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A",
        "authorized_official_last_name": "KOMOROWSKA-TIMEK",
        "authorized_official_first_name": "EWA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-206-1040",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "MI",
            "license": "4301095374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, 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 Feb 7, 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.