Healthcare Provider Details

I. General information

NPI: 1942127584
Provider Name (Legal Business Name): THE PLASTIC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10967 ALLISONVILLE RD STE 110
FISHERS IN
46038-2634
US

IV. Provider business mailing address

1121 E CALLOWAY ST
BLOOMINGTON IN
47401-8378
US

V. Phone/Fax

Practice location:
  • Phone: 317-752-1257
  • Fax:
Mailing address:
  • Phone: 317-752-1257
  • Fax:

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: ELIZABETH LUCICH
Title or Position: OWNER
Credential: MD
Phone: 317-752-1257