Basic Information
| Provider Information | |||||||||
| NPI: | 1225456809 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AESTHETIC SURGERY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 CREEKSIDE PKWY | ||||||||
| Address2: | 100 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341081943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395949100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1175 CREEKSIDE PKWY | ||||||||
| Address2: | 100 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341081943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395949100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2014 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | AGARWAL | ||||||||
| AuthorizedOfficialFirstName: | ANURAG | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2395949100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.