Provider Demographics
NPI:1730299033
Name:CALOBRACE PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:CALOBRACE PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:CALOBRACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-899-9979
Mailing Address - Street 1:2341 LIME KILN LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-899-9979
Mailing Address - Fax:502-899-9939
Practice Address - Street 1:2341 LIME KILN LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-899-9979
Practice Address - Fax:502-899-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32666174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty