MEDICARE: SONATA PLASTIC SURGERY, PLLC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1518287044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONATA PLASTIC SURGERY, PLLC

Provider Business Mailing Address
First Line	:	3260 BLAZER PKWY
Second Line	:	SUITE 102
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2116
Country	:	US
Telephone Number	:	606-483-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 BLAZER PKWY
Second Line	:	SUITE 102
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2116
Country	:	US
Telephone Number	:	606-483-7777
Fax Number	:

Authorized Official
Title or Position	:	ORGANIZER
Name	:	DR. MONICA SUSAN HALL
Credential	:	M.D.
Telephone Number	:	606-483-7777

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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