Provider Demographics
NPI:1437479987
Name:OLACK PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:OLACK PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:OLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-960-9333
Mailing Address - Street 1:10210 N 92ND ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4509
Mailing Address - Country:US
Mailing Address - Phone:480-860-9333
Mailing Address - Fax:480-451-3108
Practice Address - Street 1:10210 N 92ND ST
Practice Address - Street 2:SUITE 307
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4509
Practice Address - Country:US
Practice Address - Phone:480-860-9333
Practice Address - Fax:480-451-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty