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Physicians Plastic Surgery

Provider NPI: 1801893268

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
611 E DOUGLAS RD STE 108  MISHAWAKA, IN 46545-1464 US
Tel: 574-968-9100  Fax: 574-968-3517

Business Mailing Address:
611 E DOUGLAS RD #108 MISHAWAKA, IN 46545-1464 US
Tel: 574-968-9100  Fax: 574-968-3517

NPI Information:
NPI: 1801893268
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Plastic Surgery
Plastic Surgery
Plastic Surgery

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 208200000X





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