Provider Demographics
NPI:1558556928
Name:PLASTIC SURGERY SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:PLASTIC SURGERY SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAMALIEL
Authorized Official - Middle Name:GO
Authorized Official - Last Name:LOTUACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-531-0453
Mailing Address - Street 1:621 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2314
Mailing Address - Country:US
Mailing Address - Phone:816-531-0453
Mailing Address - Fax:816-531-2033
Practice Address - Street 1:8701 TROOST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2767
Practice Address - Country:US
Practice Address - Phone:816-531-0453
Practice Address - Fax:816-531-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416323208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS410000Medicare PIN
KSC50272Medicare UPIN