MEDICARE: AESTHETIC PLASTIC SURGERY INSTITUTE 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	2086S0122X	Plastic and Reconstructive Surgery Physician	OS9076	FL

General Provider Information

NPI Number	:	1427268796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AESTHETIC PLASTIC SURGERY INSTITUTE PA

Provider Business Mailing Address
First Line	:	4725 SW 148TH AVE STE 202
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-2124
Country	:	US
Telephone Number	:	954-752-7842
Fax Number	:	954-473-2454

Provider Business Practice Location Address
First Line	:	4725 SW 148TH AVE STE 202
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-2124
Country	:	US
Telephone Number	:	954-752-7842
Fax Number	:	954-473-2454

Authorized Official
Title or Position	:	CEO
Name	:	DR. CHARLES E GARRAMONE
Credential	:	D.O.
Telephone Number	:	954-752-7842

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	10/29/2019

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