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General NPI Number Information
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NPI Number | 1386050854
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Entity Type | Organization
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Legal Business Name | REJUVEFACE, LLC
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Dates
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Enumeration Date | 07/06/2014
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 4901 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34233-3251
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Country | US
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Telephone | 941-735-7532
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Fax |
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Provider Business Mailing Address
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Address Line | 4901 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34233-3251
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Country | US
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Telephone | 941-404-5438
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Fax | 941-953-4600
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Authorized Official
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Title or Position | FACIAL PLASTIC SURGEON
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Name | DR. MARK A CHECCONE
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Credential | MD
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Telephone | 941-735-7532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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