Healthcare Provider Details

I. General information

NPI: 1427416650
Provider Name (Legal Business Name): PLASTIKOTO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SE 5TH ST APT 916
MIAMI FL
33131-2529
US

IV. Provider business mailing address

41 SE 5TH ST APT 916
MIAMI FL
33131-2529
US

V. Phone/Fax

Practice location:
  • Phone: 404-550-9857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AJANI NUGENT
Title or Position: AUTHROIZED REPRESENTATIVE
Credential: MD
Phone: 404-550-9857