Healthcare Provider Details

I. General information

NPI: 1962577577
Provider Name (Legal Business Name): PLASTIC SURGERY SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 W MORSE BLVD
WINTER PARK FL
32789-3708
US

IV. Provider business mailing address

851 W MORSE BLVD
WINTER PARK FL
32789-3708
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-7353
  • Fax:
Mailing address:
  • Phone: 407-647-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0050906
License Number StateFL

VIII. Authorized Official

Name: DR. FRANK HENRY STIEG III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-647-4601