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General NPI Number Information
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NPI Number | 1538315494
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Entity Type | Organization
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Legal Business Name | COSMETIC SURGERY AFFILIATES LLC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 2100 NW 63RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-5111
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Country | US
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Telephone | 405-842-6677
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Fax | 405-842-6678
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Provider Business Mailing Address
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Address Line | 2100 NW 63RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-5111
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Country | US
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Telephone | 405-842-6677
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Fax | 405-842-6678
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Authorized Official
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Title or Position | MEMBER
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Name | ERIK J NUVEEN
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Credential | MD
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Telephone | 405-842-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State | OK
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