Healthcare Provider Details

I. General information

NPI: 1124246822
Provider Name (Legal Business Name): THE PLASTIC SURGERY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 HAUCK RD
CINCINNATI OH
45241-1607
US

IV. Provider business mailing address

3723 HAUCK RD
CINCINNATI OH
45241-1607
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-4440
  • Fax: 513-985-6615
Mailing address:
  • Phone: 513-769-3223
  • Fax: 513-985-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIE GANDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 513-791-4440