MEDICARE: PLASTIC AND CRANIOFACIAL SURGERY FOR INFANTS AND CHILDREN, P.A.

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	2086S0122X	Plastic and Reconstructive Surgery Physician		TX

General Provider Information

NPI Number	:	1225002538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC AND CRANIOFACIAL SURGERY FOR INFANTS AND CHILDREN, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 35046
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-0046
Country	:	US
Telephone Number	:	214-456-8834
Fax Number	:	214-456-6843

Provider Business Practice Location Address
First Line	:	6300 HARRY HINES BLVD
Second Line	:	#600
City	:	DALLAS
State	:	TX
Zip	:	75235-5259
Country	:	US
Telephone Number	:	214-456-8834
Fax Number	:	214-456-6843

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	KERRI G MITCHELL
Credential	:
Telephone Number	:	214-456-8834

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/21/2022

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