MEDICARE: AXO AESTHETICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1083014757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXO AESTHETICS PA

Provider Business Mailing Address
First Line	:	5615 TWIN RIVERS CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-7133
Country	:	US
Telephone Number	:	713-254-2747
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 TWIN RIVERS CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-7133
Country	:	US
Telephone Number	:	713-254-2747
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. KAROLY VARGA
Credential	:	MD, PHD
Telephone Number	:	713-254-2747

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	10/08/2014

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