Provider Demographics
NPI:1952581613
Name:RETSON PLASTIC SURGERYPC
Entity Type:Organization
Organization Name:RETSON PLASTIC SURGERYPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:RETSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-769-4456
Mailing Address - Street 1:8053 CLEVELAND PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5303
Mailing Address - Country:US
Mailing Address - Phone:219-769-4456
Mailing Address - Fax:219-769-1468
Practice Address - Street 1:8053 CLEVELAND PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5303
Practice Address - Country:US
Practice Address - Phone:219-769-4456
Practice Address - Fax:219-769-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-11
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100339140Medicaid
INCL9465Medicare PIN
IN703580Medicare PIN
IN100339140Medicaid