Healthcare Provider Details

I. General information

NPI: 1235650391
Provider Name (Legal Business Name): PLASTIC SURGERY PARTNERS OF FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N FRESNO ST, STE 490
FRESNO CA
93701
US

IV. Provider business mailing address

215 N FRESNO ST, STE 490
FRESNO CA
93701
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4101
  • Fax: 559-459-5744
Mailing address:
  • Phone: 559-459-4101
  • Fax: 559-459-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG24836
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA95116
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA95116
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICH STEFAN LEMKER
Title or Position: PRESIDENT
Credential: MD
Phone: 559-459-4101