Provider Demographics
NPI:1174698609
Name:PLASTIC SURGERY OF PALM BEACH
Entity type:Organization
Organization Name:PLASTIC SURGERY OF PALM BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-968-7111
Mailing Address - Street 1:4700 N CONGRESS AVE SUITE 103
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-968-7111
Mailing Address - Fax:561-968-1800
Practice Address - Street 1:4700 N CONGRESS AVE SUITE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-968-7111
Practice Address - Fax:561-968-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57756208200000X
208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063886200Medicaid
FL72968Medicare UPIN