BOREALIS PLASTIC SURGERY, PLLC (NPI# 1760777684) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760777684 |
| Entity Type | Organization |
| Organization Name | BOREALIS PLASTIC SURGERY, PLLC |
| Practice Address |
4977 Skyview Ct Traverse City MI 49684-6941 |
| Practice Telephone | 2314216599 |
| Practice Fax Number | 2314216602 |
| Mailing Telephone | 2314216599 |
| Mailing Fax Number | 2314216602 |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-08-03 |
| Authorized Official Name | DR. ADAM BRYANT SMITH (PHYSICIAN) |
| Authorized Official Telephone | 2314216599 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
4301084224 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
4977 SKYVIEW CT |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-6941 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114986098 | Timothy R. Weichert | Internal Medicine | 4977 Skyview Ct, Traverse City, MI 49684-6941 | 2006-03-21 |
| 1255853776 | Kathleen Tippen Kerr | Nurse Practitioner | 4977 Skyview Ct, Traverse City, MI 49684-6941 | 2017-07-17 |
| 1487023933 | Traverse Bay Internal Medicine PC | Internal Medicine | 4977 Skyview Ct, Traverse City, MI 49684-6941 | 2015-09-15 |
| 1629207741 | Angela Pohl | Internal Medicine | 4977 Skyview Ct, Traverse City, MI 49684-6941 | 2009-07-10 |
| 1407038151 | Tamella Paige Livengood | Nurse Practitioner | 4977 Skyview Ct, Traverse City, MI 49684-6941 | 2007-12-04 |
| 1003005315 | Adam Bryant Smith | Surgery | 4977 Skyview Ct, Traverse City, MI 49684-6941 | 2007-10-23 |
| 1770543993 | Robert Leon Pacer | Internal Medicine | 4977 Skyview Ct, Traverse City, MI 49684-6941 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487091989 | Trevor K O'brien | Surgery | 4110 Copper Ridge Dr Ste 242, Traverse City, MI 49684-6721 | 2013-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629528765 | Paragon Health, P.C. | Surgery | 8175 Creekside Dr Ste 100, Portage, MI 49024-5370 | 2016-10-13 |
| 1851689525 | Robert Moore Oneal | Surgery | 501 Onondaga St, Ann Arbor, MI 48104-2606 | 2011-07-15 |
| 1902072952 | Michigan Cosmetic & Reconstructive Surgery Pllc | Surgery | 29110 Inkster Rd, Ste 250, Southfield, MI 48034-1098 | 2008-04-30 |
| 1518184175 | Halil Ibrahim Canter | Surgery | 16001 West 9 Mile Rd., 3 Fl Fischer Ctr Providence Hosp. Craniofacial Inst., Southfield, MI 48075 | 2007-04-18 |
| 1285756148 | Andrea Emma Van Pelt | Surgery | 4070 Lake Drive Se, Suite 202, Grand Rapids, MI 49546 | 2007-04-04 |
| 1083741367 | Kenneth Wolf | Surgery | 1990 Union Lake Rd Ste 200, Commerce Township, MI 48382-2200 | 2007-02-27 |
| 1972630259 | Lauran Bryan | Surgery | 26711 Woodward Ave Ste Ll1, Huntington Woods, MI 48070-1370 | 2007-02-27 |
| 1689761439 | John J Iacobucci | Surgery | 221 Michigan St Ne Ste 300, Grand Rapids, MI 49503-2537 | 2006-10-05 |
| 1710996319 | Ewa D Komorowska-timek | Surgery | 3855 Burton St Se Ste A, Grand Rapids, MI 49546-5816 | 2006-08-05 |
| 1689689259 | Milena Diana Lambie | Surgery | 27750 Middlebelt Rd Ste 150, Farmington Hills, MI 48334-5007 | 2006-07-30 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.