1912938598 NPI number — ORLANDO COSMETIC SURGERY LLC DBA ALTIORA PLASTIC SURGERY & MED SPA

Table of content: DR. MOHAMMAD MAHMOUD ALKHAWAJA MD (NPI 1598326829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912938598 NPI number — ORLANDO COSMETIC SURGERY LLC DBA ALTIORA PLASTIC SURGERY & MED SPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO COSMETIC SURGERY LLC DBA ALTIORA PLASTIC SURGERY & MED SPA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912938598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGBOAT KEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-388-1110
Provider Business Mailing Address Fax Number:
941-388-1119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 N ORANGE AVE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32804-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-681-3223
Provider Business Practice Location Address Fax Number:
407-681-0976
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CICILIONI
Authorized Official First Name:
ORLANDO
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
SENIOR PHYSICIAN
Authorized Official Telephone Number:
941-388-1110

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  ME0065746 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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