MEDICARE: BISWAS 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	46446	AZ

General Provider Information

NPI Number	:	1982087441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BISWAS PLASTIC SURGERY, PLLC

Provider Business Mailing Address
First Line	:	5121 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1403
Country	:	US
Telephone Number	:	602-266-2772
Fax Number	:	602-266-4856

Provider Business Practice Location Address
First Line	:	5121 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1403
Country	:	US
Telephone Number	:	602-266-2772
Fax Number	:	602-266-4856

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ATANU BISWAS
Credential	:	M.D.
Telephone Number	:	520-405-3170

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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