Provider Demographics
NPI:1417283862
Name:CINCINNATI INSTITUE OF PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:CINCINNATI INSTITUE OF PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-793-5772
Mailing Address - Street 1:10577 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4451
Mailing Address - Country:US
Mailing Address - Phone:513-793-5772
Mailing Address - Fax:513-792-5384
Practice Address - Street 1:10577 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4451
Practice Address - Country:US
Practice Address - Phone:513-793-5772
Practice Address - Fax:513-792-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057586208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF25646Medicare UPIN
OHMC0715401Medicare PIN