Healthcare Provider Details

I. General information

NPI: 1780755827
Provider Name (Legal Business Name): CONTEMPORARY COSMETIC SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 PARK EAST DR SUITE 107
BEACHWOOD OH
44122-4338
US

IV. Provider business mailing address

PO BOX 22958
CLEVELAND OH
44122-0958
US

V. Phone/Fax

Practice location:
  • Phone: 216-595-6800
  • Fax: 216-593-0414
Mailing address:
  • Phone: 216-595-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN J MICHELOW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 216-595-6800