MEDICARE: KEY WEST INSTITUTE OF PLASTIC SURGERY

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	ME67948	FL

General Provider Information

NPI Number	:	1861814071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEY WEST INSTITUTE OF PLASTIC SURGERY

Provider Business Mailing Address
First Line	:	3140 NORTHSIDE DR
Second Line	:	BUILDING A
City	:	KEY WEST
State	:	FL
Zip	:	33040-8011
Country	:	US
Telephone Number	:	305-809-8011
Fax Number	:	305-809-8011

Provider Business Practice Location Address
First Line	:	3140 NORTHSIDE DR
Second Line	:	BUILDING A
City	:	KEY WEST
State	:	FL
Zip	:	33040-8011
Country	:	US
Telephone Number	:	305-809-8011
Fax Number	:	305-809-8011

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT LOESSIN
Credential	:	MD
Telephone Number	:	305-809-8011

Provider Enumeration Date	:	01/08/2014
Last Update Date	:	01/08/2014

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