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NPI Code Detail

MEDICARE: KP AESTHETICS, LLC.

MEDICARE: KP AESTHETICS, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician

General Provider Information

NPI Number : 1205348141
Entity Type Code : Organization
Provider Name (Legal Business Name) : KP AESTHETICS, LLC.
Provider Business Mailing Address
First Line : 4675 W CHESTER PIKE
Second Line :
City : NEWTOWN SQUARE
State : PA
Zip : 19073-2227
Country : US
Telephone Number : 484-420-4094
Fax Number :
Provider Business Practice Location Address
First Line : 4675 W CHESTER PIKE
Second Line :
City : NEWTOWN SQUARE
State : PA
Zip : 19073-2227
Country : US
Telephone Number : 484-420-4094
Fax Number :
Authorized Official
Title or Position : OWNER
Name : STEVEN COSTALAS
Credential : M.D.
Telephone Number : 484-420-4094
Provider Enumeration Date : 11/01/2017
Last Update Date : 11/01/2017

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