Provider Demographics
NPI:1467812529
Name:COSMETIC AND RECONSTRUCTIVE SPECIALISTS OF FLORIDA, PLLC
Entity Type:Organization
Organization Name:COSMETIC AND RECONSTRUCTIVE SPECIALISTS OF FLORIDA, PLLC
Other - Org Name:COSMETIC AND RECONSTRUCTIVE SPECIALIST OF FLORIDA
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-632-7645
Mailing Address - Street 1:906 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3607
Mailing Address - Country:US
Mailing Address - Phone:305-632-7645
Mailing Address - Fax:
Practice Address - Street 1:906 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3607
Practice Address - Country:US
Practice Address - Phone:305-632-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty