Provider Demographics
NPI:1790566016
Name:HIMMARSHEE PLASTIC SURGERY PARTNERS
Entity Type:Organization
Organization Name:HIMMARSHEE PLASTIC SURGERY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAVANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-707-5158
Mailing Address - Street 1:717 SE 2ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3639
Mailing Address - Country:US
Mailing Address - Phone:954-707-5158
Mailing Address - Fax:
Practice Address - Street 1:717 SE 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3639
Practice Address - Country:US
Practice Address - Phone:954-707-5158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty