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NPI Code Detail

MEDICARE: PLASTIK CERRAHI, LLC

MEDICARE: PLASTIK CERRAHI, LLC
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
12086S0122XPlastic and Reconstructive Surgery PhysicianFL

General Provider Information

NPI Number : 1619341807
Entity Type Code : Organization
Provider Name (Legal Business Name) : PLASTIK CERRAHI, LLC
Provider Business Mailing Address
First Line : 1702 OHIO AVE
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-4290
Country : US
Telephone Number : 850-647-8825
Fax Number : 850-571-5845
Provider Business Practice Location Address
First Line : 1702 OHIO AVE
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-4290
Country : US
Telephone Number : 850-647-8825
Fax Number : 850-571-5845
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : ADIL CYEDELI
Credential : M.D.
Telephone Number : 850-867-8595
Provider Enumeration Date : 11/25/2015
Last Update Date : 11/25/2015

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Directions to “PLASTIK CERRAHI, LLC ” Practice Location

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