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General NPI Number Information
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NPI Number | 1912086240
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Entity Type | Organization
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Legal Business Name | WESTERN RESERVE PLASTIC SURGERY
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5005 ROCKSIDE RD #640
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2194
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Country | US
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Telephone | 216-328-0800
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Fax | 330-328-1860
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Provider Business Mailing Address
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Address Line | 5005 ROCKSIDE RD #640
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2194
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Country | US
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Telephone | 216-328-0800
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Fax | 330-328-1860
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Authorized Official
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Title or Position | CEO
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Name | GEORGE J PICHA
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Credential | MD
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Telephone | 216-328-0800
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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 | 35051876P
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License Number State | OH
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