Provider Demographics
NPI:1780269449
Name:PARKINS PLASTIC SURGERY
Entity type:Organization
Organization Name:PARKINS PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:PARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-704-2155
Mailing Address - Street 1:685 E VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4766
Mailing Address - Country:US
Mailing Address - Phone:414-704-2155
Mailing Address - Fax:262-205-1463
Practice Address - Street 1:685 E VALLEY RD
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4766
Practice Address - Country:US
Practice Address - Phone:414-704-2155
Practice Address - Fax:262-205-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty