Provider Demographics
NPI:1235515453
Name:SKYLINE PLASTIC AND HAND SURGERY LLC
Entity Type:Organization
Organization Name:SKYLINE PLASTIC AND HAND SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-499-7398
Mailing Address - Street 1:6112 S 1550 E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5007
Mailing Address - Country:US
Mailing Address - Phone:801-499-7398
Mailing Address - Fax:
Practice Address - Street 1:6112 S 1550 E
Practice Address - Street 2:SUITE 102
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-5007
Practice Address - Country:US
Practice Address - Phone:801-499-7398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty