Healthcare Provider Details

I. General information

NPI: 1871560227
Provider Name (Legal Business Name): PLASTIC SURGERY CONSULTANTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 281B
SAINT LOUIS MO
63128-2109
US

IV. Provider business mailing address

10004 KENNERLY RD STE 283B
SAINT LOUIS MO
63128-2177
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-5885
  • Fax: 314-272-0866
Mailing address:
  • Phone: 314-272-0864
  • Fax: 314-272-0866

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: EDMOND B CABBABE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-272-0864