Provider Demographics
NPI:1174217889
Name:PLASTIC SURGERY CONTRACTING ASSOCIATES, LLC
Entity type:Organization
Organization Name:PLASTIC SURGERY CONTRACTING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIESNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-738-7200
Mailing Address - Street 1:5605 W WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8438
Mailing Address - Country:US
Mailing Address - Phone:920-738-7200
Mailing Address - Fax:920-273-2500
Practice Address - Street 1:5605 W WATERFORD LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8438
Practice Address - Country:US
Practice Address - Phone:920-738-7200
Practice Address - Fax:920-273-2500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLETON PLASTIC SURGERY CENTER, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty