Provider Demographics
NPI:1174776033
Name:PLASTIC SURGERY AFFILIATES PC
Entity type:Organization
Organization Name:PLASTIC SURGERY AFFILIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HASHIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-355-9911
Mailing Address - Street 1:30603 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7729
Mailing Address - Country:US
Mailing Address - Phone:248-355-9911
Mailing Address - Fax:248-355-9961
Practice Address - Street 1:30603 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7729
Practice Address - Country:US
Practice Address - Phone:248-355-9911
Practice Address - Fax:248-355-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI032600207LC0200X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1981890Medicaid
MI507512OtherPRIORTY
MI5219023OtherAETNA
MI6195OtherGREAT WEST
MID85235OtherHAP
MID85235Medicare UPIN
MI0638157Medicare UPIN
MI0638157Medicare PIN