Provider Demographics
NPI:1205983152
Name:PARKWAY PLASTIC SURGERY, P.C.
Entity type:Organization
Organization Name:PARKWAY PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-343-5750
Mailing Address - Street 1:575 W CROSSTOWN PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1977
Mailing Address - Country:US
Mailing Address - Phone:269-343-5750
Mailing Address - Fax:269-343-4936
Practice Address - Street 1:575 W CROSSTOWN PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1977
Practice Address - Country:US
Practice Address - Phone:269-343-5750
Practice Address - Fax:269-343-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010399632086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4167184Medicaid
MI4167184Medicaid
MI0M93970Medicare PIN