Healthcare Provider Details

I. General information

NPI: 1952581613
Provider Name (Legal Business Name): RETSON PLASTIC SURGERYPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2007
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8053 CLEVELAND PL
MERRILLVILLE IN
46410-5303
US

IV. Provider business mailing address

8053 CLEVELAND PL
MERRILLVILLE IN
46410-5303
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-4456
  • Fax: 219-769-1468
Mailing address:
  • Phone: 219-769-4456
  • Fax: 219-769-1468

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: MR. NICHOLAS C RETSON
Title or Position: PROPRIETOR
Credential: M.D.
Phone: 219-769-4456