Provider Demographics
NPI:1922358514
Name:AUTHENTIC PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:AUTHENTIC PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PAWEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STACHOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-360-6466
Mailing Address - Street 1:2000 PLYMOUTH ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2335
Mailing Address - Country:US
Mailing Address - Phone:612-360-6466
Mailing Address - Fax:
Practice Address - Street 1:2000 PLYMOUTH ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2335
Practice Address - Country:US
Practice Address - Phone:612-360-6466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty