Provider Demographics
NPI:1891907424
Name:ADVANCED CONCPETS IN PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:ADVANCED CONCPETS IN PLASTIC SURGERY PA
Other - Org Name:DR. SURESH KONERU
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KONERU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-499-5900
Mailing Address - Street 1:423 TREELINE PARK
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-499-5900
Mailing Address - Fax:210-333-4975
Practice Address - Street 1:423 TREELINE PARK
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-499-5900
Practice Address - Fax:210-333-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029455502Medicaid
TX00W141Medicare PIN