Provider Demographics
NPI:1679525653
Name:CENTER FOR AESTHETIC PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:CENTER FOR AESTHETIC PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UTPALKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:352-796-3334
Mailing Address - Street 1:17222 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 346
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601
Mailing Address - Country:US
Mailing Address - Phone:352-796-3334
Mailing Address - Fax:352-796-3323
Practice Address - Street 1:17222 HOSPITAL BOULEVARD
Practice Address - Street 2:SUITE 346
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601
Practice Address - Country:US
Practice Address - Phone:352-796-3334
Practice Address - Fax:352-796-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73174207N00000X
FLME79778208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA2302OtherRAILROAD MEDICARE
FLK2083Medicare ID - Type UnspecifiedPROVIDER NUMBER