Provider Demographics
NPI:1720319403
Name:BODY CONTOURING INC
Entity Type:Organization
Organization Name:BODY CONTOURING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-489-6212
Mailing Address - Street 1:PO BOX 4542
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33677-4542
Mailing Address - Country:US
Mailing Address - Phone:813-489-6212
Mailing Address - Fax:813-489-6214
Practice Address - Street 1:301 W PLATT ST
Practice Address - Street 2:#30
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2292
Practice Address - Country:US
Practice Address - Phone:813-489-6212
Practice Address - Fax:813-489-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96314208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001701600Medicaid
FL001701600Medicaid
FLCY460ZMedicare UPIN