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NPI Code Detail

MEDICARE: UNIVERSITY PLASTIC SURGERY ASSOCIATES INC

MEDICARE: UNIVERSITY PLASTIC SURGERY ASSOCIATES INC
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
1208200000XPlastic Surgery Physician
22082S0099XPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
32082S0105XSurgery of the Hand (Plastic Surgery) Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CA9604OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245285410
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY PLASTIC SURGERY ASSOCIATES INC
Provider Business Mailing Address
First Line : 5910 LANDERBROOK DR
Second Line : SUITE 250
City : MAYFIELD HTS
State : OH
Zip : 44124-6508
Country : US
Telephone Number : 440-684-5865
Fax Number : 440-449-1555
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1736
Country : US
Telephone Number : 216-844-4780
Fax Number :
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : VALERIE ROWAN
Credential :
Telephone Number : 216-844-4780
Provider Enumeration Date : 05/24/2006
Last Update Date : 09/11/2025

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