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General NPI Number Information
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NPI Number | 1184997470
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Entity Type | Organization
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Legal Business Name | BEAUTY MARK PLASTIC SURGERY, PA
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 100 NW 82ND AVE SUITE 405
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City | PLANTATION
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State | FL
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Zip | 33324-7809
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Country | US
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Telephone | 954-474-3792
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Fax | 954-474-3795
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Provider Business Mailing Address
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Address Line | 100 NW 82ND AVE SUITE 405
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City | PLANTATION
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State | FL
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Zip | 33324-7809
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Country | US
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Telephone | 954-474-3792
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Fax | 954-474-3795
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALBERIK KESHISHIAN
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Credential | D.O.
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Telephone | 954-593-2965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | OS 10442
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License Number State | FL
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