Provider Demographics
NPI:1710745559
Name:VENUS BREAST CENTER PLLC
Entity Type:Organization
Organization Name:VENUS BREAST CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRAL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-760-3339
Mailing Address - Street 1:200 N KIMBALL AVE, SUITE 221
Mailing Address - Street 2:#1135
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:248-760-3339
Mailing Address - Fax:
Practice Address - Street 1:630 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4410
Practice Address - Country:US
Practice Address - Phone:248-760-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center