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General NPI Number Information
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NPI Number | 1811784093
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Entity Type | Organization
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Legal Business Name | MP PLASTIC SURGERY KS LLC
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 551 N HILLSIDE ST STE 550
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City | WICHITA
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State | KS
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Zip | 67214-4928
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Country | US
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Telephone | 817-529-9199
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Fax |
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Provider Business Mailing Address
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Address Line | 800 8TH AVE STE 206
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City | FORT WORTH
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State | TX
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Zip | 76104-2619
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Country | US
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Telephone | 817-529-9199
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | KACIE KAUFMAN
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Credential |
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Telephone | 817-529-9199
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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 |
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License Number State |
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