MEDICARE: CLINIC FOR PLASTIC SURGERY 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

General Provider Information

NPI Number	:	1902467483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINIC FOR PLASTIC SURGERY PA

Provider Business Mailing Address
First Line	:	1616 CLEAR LAKE CITY BLVD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-8069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14018 AESTHETIC CIR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-2373
Country	:	US
Telephone Number	:	281-990-8487
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMIR M SUKKAR
Credential	:	MD
Telephone Number	:	281-990-8487

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	08/11/2021

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