Healthcare Provider Details

I. General information

NPI: 1578676870
Provider Name (Legal Business Name): PLASTIC SURGERY INSTITUTE OF THE PALM BEACHES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 MILITARY TRL SUITE 208
JUPITER FL
33458-4834
US

IV. Provider business mailing address

4601 MILITARY TRAIL SUITE 208
JUPITER FL
33458
US

V. Phone/Fax

Practice location:
  • Phone: 561-795-3787
  • Fax: 561-798-0003
Mailing address:
  • Phone: 561-795-3787
  • Fax: 561-798-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS0005647
License Number StateFL

VIII. Authorized Official

Name: DR. HAROLD BAFITIS
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 561-795-3787