Provider Demographics
NPI:1003003195
Name:AVENTURA DERMATOLOGY & COSMETIC CENTER, P.A.
Entity Type:Organization
Organization Name:AVENTURA DERMATOLOGY & COSMETIC CENTER, P.A.
Other - Org Name:FT. LAUDERDALE DERMATOLOGY AND COSMETIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPLIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-772-0416
Mailing Address - Street 1:5721 NE 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2703
Mailing Address - Country:US
Mailing Address - Phone:954-772-0416
Mailing Address - Fax:954-772-5716
Practice Address - Street 1:5721 NE 27TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2703
Practice Address - Country:US
Practice Address - Phone:954-772-0416
Practice Address - Fax:954-772-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty