Provider Demographics
NPI:1659549608
Name:PLASTIC SURGERY AFFILIATES
Entity Type:Organization
Organization Name:PLASTIC SURGERY AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUENEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-327-0303
Mailing Address - Street 1:1914 CHARLOTTE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2107
Mailing Address - Country:US
Mailing Address - Phone:615-327-0303
Mailing Address - Fax:615-241-0242
Practice Address - Street 1:1914 CHARLOTTE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2107
Practice Address - Country:US
Practice Address - Phone:615-327-0303
Practice Address - Fax:615-241-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377028Medicare PIN