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General NPI Number Information
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NPI Number | 1487793261
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Entity Type | Organization
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Legal Business Name | COSMETIC AND PLASTIC SURGERY SPECIALISTS
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 201 N MAYFAIR RD SUITE 530
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City | WAUWATOSA
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State | WI
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Zip | 53226-4216
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Country | US
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Telephone | 414-443-0033
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Fax | 414-443-0034
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Provider Business Mailing Address
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Address Line | 201 N MAYFAIR RD SUITE 530
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City | WAUWATOSA
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State | WI
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Zip | 53226-4216
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Country | US
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Telephone | 414-443-0033
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Fax | 414-443-0034
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARVEY MICHAEL BOCK
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Credential | M.D.
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Telephone | 414-443-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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