Provider Demographics
NPI:1720179674
Name:COLUMBUS INSTITUTE OF PLASTIC SURGERY LTD
Entity Type:Organization
Organization Name:COLUMBUS INSTITUTE OF PLASTIC SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIVIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-235-2326
Mailing Address - Street 1:6499 E BROAD ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6505
Mailing Address - Country:US
Mailing Address - Phone:614-322-2500
Mailing Address - Fax:614-322-2532
Practice Address - Street 1:6499 E BROAD ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6505
Practice Address - Country:US
Practice Address - Phone:614-235-2326
Practice Address - Fax:614-235-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9344781Medicare ID - Type Unspecified