Healthcare Provider Details

I. General information

NPI: 1962568675
Provider Name (Legal Business Name): CRYSTAL PLASTIC SURGEONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 EMBASSY PKWY
AKRON OH
44333-1763
US

IV. Provider business mailing address

3925 EMBASSY PKWY
AKRON OH
44333-1763
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-4065
  • Fax: 330-670-4160
Mailing address:
  • Phone: 330-668-4065
  • Fax: 330-670-4160

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: GLENNA KREITZBURG
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-668-4065