Provider Demographics
NPI:1831425677
Name:PLASTIC SURGERY INTERNATIONAL LLC
Entity type:Organization
Organization Name:PLASTIC SURGERY INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TADJALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-878-2278
Mailing Address - Street 1:969 N MASON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6338
Mailing Address - Country:US
Mailing Address - Phone:314-878-2278
Mailing Address - Fax:314-878-2311
Practice Address - Street 1:969 N MASON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6338
Practice Address - Country:US
Practice Address - Phone:314-878-2278
Practice Address - Fax:314-878-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116731208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000094908Medicare PIN