Healthcare Provider Details

I. General information

NPI: 1821530098
Provider Name (Legal Business Name): UP PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
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: 281-724-1024
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 Number
License Number State

VIII. Authorized Official

Name: DR. SHITEL PATEL
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 832-835-1131