Provider Demographics
NPI:1609653708
Name:FLORIDA INSTITUTE OF PLASTIC SURGERY
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE OF PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-325-5555
Mailing Address - Street 1:8550 NE 138TH LN STE 102
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6816
Mailing Address - Country:US
Mailing Address - Phone:352-325-5555
Mailing Address - Fax:346-202-0106
Practice Address - Street 1:8550 NE 138TH LN STE 102
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6816
Practice Address - Country:US
Practice Address - Phone:352-325-5555
Practice Address - Fax:346-202-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty