| Organization Name: | MANGAT-KUY-HOLZAPFEL PLASTIC SURGERY CENTER PSC |
| NPI Number: | 1043356504 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY BURKE (CREDENTIALING SPECIALIST) |
| Mailing Address: | 133 Barnwood Dr Edgewood |
| State: | KY US |
| Postal Code: | 410172500 |
| Phone Number: | 8593319600 |
| Fax Number: | 8595783321 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 05/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |