Provider Demographics
NPI:1831425347
Name:PLASTIC SURGERY AESTHETICS PC
Entity type:Organization
Organization Name:PLASTIC SURGERY AESTHETICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-589-9119
Mailing Address - Street 1:200 MERCY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7392
Mailing Address - Country:US
Mailing Address - Phone:563-589-9119
Mailing Address - Fax:563-589-9112
Practice Address - Street 1:200 MERCY DR STE 101
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7392
Practice Address - Country:US
Practice Address - Phone:563-589-9119
Practice Address - Fax:563-589-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA318522086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty