Healthcare Provider Details
I. General information
NPI: 1538341995
Provider Name (Legal Business Name): ARTFUL COSMETIC & SKIN CANCER SURGERY CENTERS PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/28/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6565 WEST LOOP S STE 800
BELLAIRE TX
77401-3505
US
IV. Provider business mailing address
4811 VALERIE ST
BELLAIRE TX
77401-5705
US
V. Phone/Fax
- Phone: 713-443-8731
- Fax:
- Phone: 713-443-8731
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207ND0101X |
| Taxonomy | MOHS-Micrographic Surgery Physician |
| License Number | M3498 |
| License Number State | TX |
VIII. Authorized Official
Name: DR.
SUNEEL
CHILUKURI
Title or Position: OWNER
Credential: M.D.
Phone: 713-443-8731