MEDICARE: MIAMI AESTHETIC SURGERY ASSOCIATES 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
1	2086S0122X	Plastic and Reconstructive Surgery Physician	ME116714	FL

General Provider Information

NPI Number	:	1689186561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI AESTHETIC SURGERY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	51 SW 42ND AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1770
Country	:	US
Telephone Number	:	305-514-0318
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 SW 42ND AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1770
Country	:	US
Telephone Number	:	305-514-0318
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVER CHANG
Credential	:	MD
Telephone Number	:	305-514-0318

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	03/17/2018

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