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General NPI Number Information
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NPI Number | 1871724500
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Entity Type | Organization
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Legal Business Name | OMNIVERSE PLASTIKOS PA
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 14 PROFESSIONAL PKWY SUITE C
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City | RIDGELAND
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State | MS
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Zip | 39157-4190
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Country | US
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Telephone | 601-824-1492
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Fax |
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Provider Business Mailing Address
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Address Line | 1888 MAIN ST SUITE C, #272
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City | MADISON
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State | MS
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Zip | 39110-6337
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Country | US
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Telephone | 601-824-1492
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARNO RENE SCHLEICH
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Credential | MD
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Telephone | 601-824-1492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | 20023
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number | 20023
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 20023
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License Number State | MS
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