Provider Demographics
NPI:1780824995
Name:MICHAEL J BASS PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:MICHAEL J BASS PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-543-1024
Mailing Address - Street 1:2716 OLD ROSEBUD RD
Mailing Address - Street 2:SUITE 350A
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8008
Mailing Address - Country:US
Mailing Address - Phone:859-543-1024
Mailing Address - Fax:
Practice Address - Street 1:2716 OLD ROSEBUD RD
Practice Address - Street 2:SUITE 350A
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8008
Practice Address - Country:US
Practice Address - Phone:859-543-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01058Medicare PIN