Provider Demographics
NPI:1952527178
Name:UTICA PLASTIC SURGERY INC
Entity Type:Organization
Organization Name:UTICA PLASTIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-582-6958
Mailing Address - Street 1:1145 S UTICA AVE
Mailing Address - Street 2:SUITE 1109
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4000
Mailing Address - Country:US
Mailing Address - Phone:918-582-6958
Mailing Address - Fax:918-582-8155
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:SUITE 1109
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4000
Practice Address - Country:US
Practice Address - Phone:918-582-6958
Practice Address - Fax:918-582-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK129822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK444447183001OtherBLUECROSS & BLUESHIELD
OK444447183001OtherBLUECROSS & BLUESHIELD