=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124970603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAMD PLASTIC SURGERY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2026
-----------------------------------------------------
Last Update Date | 02/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4701 BEE CAVES RD STE 106
-----------------------------------------------------
City | WEST LAKE HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-5366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 514-543-1000
-----------------------------------------------------
Fax | 512-581-9492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4701 BEE CAVES RD STE 106
-----------------------------------------------------
City | WEST LAKE HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-5366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 514-543-1000
-----------------------------------------------------
Fax | 512-581-9492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARCELO B ANTUNES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 512-543-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0007X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------