=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538341995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARTFUL COSMETIC & SKIN CANCER SURGERY CENTERS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2007
-----------------------------------------------------
Last Update Date | 02/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6565 WEST LOOP S STE 800
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-443-8731
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4811 VALERIE ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-5705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-443-8731
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SUNEEL CHILUKURI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-443-8731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ND0101X
-----------------------------------------------------
Taxonomy Name | MOHS-Micrographic Surgery Physician
-----------------------------------------------------
License Number | M3498
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------