Healthcare Provider Details

I. General information

NPI: 1144770363
Provider Name (Legal Business Name): LIFT PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GENESIS BLVD STE B
WEBSTER TX
77598-1636
US

IV. Provider business mailing address

210 GENESIS BLVD STE B
WEBSTER TX
77598-1636
US

V. Phone/Fax

Practice location:
  • Phone: 832-835-1131
  • Fax: 832-918-3223
Mailing address:
  • Phone: 832-835-1131
  • Fax: 832-918-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberP7832
License Number StateTX

VIII. Authorized Official

Name: DR. SHITEL PATEL
Title or Position: M.D.
Credential: M.D.
Phone: 813-310-5057