Provider Demographics
NPI:1275562910
Name:KEVIN MAYFIELD PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:KEVIN MAYFIELD PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BILL
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-856-8100
Mailing Address - Street 1:8230 BECKETT PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-856-8100
Mailing Address - Fax:513-870-5242
Practice Address - Street 1:8230 BECKETT PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-856-8100
Practice Address - Fax:513-870-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-059939208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKE9359221Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER