Provider Demographics
NPI:1184997470
Name:BEAUTY MARK PLASTIC SURGERY, PA
Entity type:Organization
Organization Name:BEAUTY MARK PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHISHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-593-2965
Mailing Address - Street 1:100 NW 82ND AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7809
Mailing Address - Country:US
Mailing Address - Phone:954-474-3792
Mailing Address - Fax:954-474-3795
Practice Address - Street 1:100 NW 82ND AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7809
Practice Address - Country:US
Practice Address - Phone:954-474-3792
Practice Address - Fax:954-474-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 104422086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty