Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Executive Plastic Surgery, PLLC

Organization Plastic Surgery Physician · NPI 1649675174

Executive Plastic Surgery, PLLC is a Plastic Surgery Physician in Bloomfield Hills, Michigan. Licensed in Michigan. Registered with an NPI since 2014.

Licensed in
MI
In the registry since
2014
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

43940 Woodward Ave Ste 100
Bloomfield Hills, MI 48302-5025
Phone: (734) 419-1615
Fax: (248) 934-2185
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic Surgery Physician (primary) Taxonomy 208200000X · Licence 4301098160 (MI)

Record details

NPI number1649675174
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shaher Khan — Ceo · (734) 419-1615
Other names Crescent Plastic Surgery, Pllc
NPI enumeratedOctober 27, 2014
Last updated in NPPESMarch 22, 2024
Certification dateMarch 22, 2024
Mailing address43940 Woodward Ave Ste 100, Bloomfield Hills, MI 48302-5025

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