MEDICARE: DUET PLASTIC SURGERY, A MEDICAL CORPORATION

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
1	208200000X	Plastic Surgery Physician	A84000	CA

General Provider Information

NPI Number	:	1548579493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUET PLASTIC SURGERY, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1515 EL CAMINO REAL
Second Line	:	SUITE D
City	:	PALO ALTO
State	:	CA
Zip	:	94306-1052
Country	:	US
Telephone Number	:	650-380-0415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 EL CAMINO REAL
Second Line	:	SUITE D
City	:	PALO ALTO
State	:	CA
Zip	:	94306-1052
Country	:	US
Telephone Number	:	650-380-0415
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JENNIFER WEINTRAUB
Credential	:	M.D.
Telephone Number	:	650-380-0415

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	09/27/2010

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