Provider Demographics
NPI:1144770363
Name:LIFT PLASTIC SURGERY
Entity Type:Organization
Organization Name:LIFT PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:SHITEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-310-5057
Mailing Address - Street 1:210 GENESIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1636
Mailing Address - Country:US
Mailing Address - Phone:832-835-1131
Mailing Address - Fax:832-918-3223
Practice Address - Street 1:210 GENESIS BLVD STE B
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1636
Practice Address - Country:US
Practice Address - Phone:832-835-1131
Practice Address - Fax:832-918-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty