Provider Demographics
NPI:1225456809
Name:AESTHETIC SURGERY CENTER INC
Entity Type:Organization
Organization Name:AESTHETIC SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANURAG
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-594-9100
Mailing Address - Street 1:1175 CREEKSIDE PKWY
Mailing Address - Street 2:100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1943
Mailing Address - Country:US
Mailing Address - Phone:239-594-9100
Mailing Address - Fax:
Practice Address - Street 1:1175 CREEKSIDE PKWY
Practice Address - Street 2:100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1943
Practice Address - Country:US
Practice Address - Phone:239-594-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHU966AMedicare PIN