Provider Demographics
NPI:1144256777
Name:CONSULTANTS IN OPHTHALMIC & FACIAL PLASTIC SURGERY
Entity type:Organization
Organization Name:CONSULTANTS IN OPHTHALMIC & FACIAL PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:NESI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-357-5100
Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 324
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-357-5100
Mailing Address - Fax:248-746-0683
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 324
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-357-5100
Practice Address - Fax:248-746-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGG041157207W00000X
MISM011371207W00000X
MIEB071533207W00000X
MINK079942207W00000X
MIFN035694207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION52410Medicare ID - Type Unspecified