Provider Demographics
NPI:1134573496
Name:DEPERRO PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:DEPERRO PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPERRO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:614-940-6607
Mailing Address - Street 1:1830 BETHEL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1809
Mailing Address - Country:US
Mailing Address - Phone:614-429-4950
Mailing Address - Fax:614-429-4948
Practice Address - Street 1:1830 BETHEL RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1809
Practice Address - Country:US
Practice Address - Phone:614-429-4950
Practice Address - Fax:614-429-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty