Borealis Plastic Surgery, PLLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

4301084224 Issued in MI

Legal business name

BOREALIS PLASTIC SURGERY, PLLC

Practice address

4977 Skyview CT
Traverse City, MI 49684-6941

Phone

(231) 421-6599

Fax

(231) 421-6602

NPI assigned

Jun 20, 2011

Last updated

Aug 3, 2011By 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. Adam Bryant Smith, MDNPI 1003005315

Title

Physician

Phone

(231) 421-6599

Specialties & licenses 1

Addresses

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.

• Adam Bryant Smith, MD

  • Plastic and Reconstructive Surgery Physician
  • Traverse City, MI
  • NPI 1003005315
  Authorized official Same address or phone

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312329600000",
    "number": "1760777684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4977 SKYVIEW CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846941",
            "telephone_number": "231-421-6599",
            "fax_number": "231-421-6602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4977 SKYVIEW CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846941",
            "telephone_number": "231-421-6599",
            "fax_number": "231-421-6602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOREALIS PLASTIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-08-03",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "BRYANT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "231-421-6599",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301084224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Maria Boonzaaijer, COTA/L, CDP
• Alyson M Booth, MD
• Lori Boothroyd, PH.D.
• Katharene May Bopry
• Leah Borchardt, MA, LLPC
• Thomas William Borgeld, PH.D.
• Brooke Alice Borgeson-Gray, NP
• Amy Borgman, PH.D.
• Dawn Colleen Borgula, MSN, FNP-BC
• Matthew Born, PHARMD

• Plastic and Reconstructive Surgery Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Plastic and Reconstructive Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; 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.