Provider Demographics
NPI:1861502593
Name:ST PAUL PLASTIC SURGERY LTD
Entity Type:Organization
Organization Name:ST PAUL PLASTIC SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEMAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-646-2717
Mailing Address - Street 1:393 N DUNLAP ST
Mailing Address - Street 2:832
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-646-2717
Mailing Address - Fax:651-646-5144
Practice Address - Street 1:393 N DUNLAP ST
Practice Address - Street 2:832
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-646-2717
Practice Address - Fax:651-646-5144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02656Medicare ID - Type Unspecified