Provider Demographics
NPI:1578445698
Name:WEST MAPLE PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:WEST MAPLE PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESANO
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:248-797-9277
Mailing Address - Street 1:5807 W MAPLE RD STE 177
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4483
Mailing Address - Country:US
Mailing Address - Phone:248-865-6400
Mailing Address - Fax:
Practice Address - Street 1:5807 W MAPLE RD STE 177
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4483
Practice Address - Country:US
Practice Address - Phone:248-865-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty