Healthcare Provider Details

I. General information

NPI: 1942303128
Provider Name (Legal Business Name): MARROCCO PLASTIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W CARMEL DR SUITE #202
CARMEL IN
46032-5877
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 317-815-8985
  • Fax: 317-815-8982
Mailing address:
  • Phone: 317-870-6745
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MARROCCO
Title or Position: OWNER
Credential: MD
Phone: 317-815-8985