Provider Demographics
NPI:1326016395
Name:AESTHETIC SURGERY OF KALAMAZOO PC
Entity Type:Organization
Organization Name:AESTHETIC SURGERY OF KALAMAZOO PC
Other - Org Name:FRANK J NEWMAN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-343-1382
Mailing Address - Street 1:500 W CROSSTOWN PRKWY
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1995
Mailing Address - Country:US
Mailing Address - Phone:269-343-1382
Mailing Address - Fax:269-343-6759
Practice Address - Street 1:500 W CROSSTOWN PRKWY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1995
Practice Address - Country:US
Practice Address - Phone:269-343-1382
Practice Address - Fax:269-343-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030660208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D91311Medicare UPIN
MI0398785Medicare ID - Type Unspecified