Polavarapu Plastic Surgery, PLLC
Plastic Surgery in Fort Worth, TX. Organization (NPI-2).
NPI number1982148326
StatusActive
Last updated in NPPESJan 31, 2017
Details
- NPI
- 1982148326
- Entity type
- Organization (NPI-2)
- Legal business name
- Polavarapu Plastic Surgery, PLLC
- Organization subpart
- No
- Enumeration date
- Dec 5, 2016
- Last updated
- Jan 31, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208200000X | Plastic Surgery | Q0809 | TX | Yes |
Practice location
4455 Camp Bowie BlvdSuite 114-30
Fort Worth, TX 76107-3864
Phone 773-710-6128
Mailing address
4455 Camp Bowie BlvdSuite 114-30
Fort Worth, TX 76107-3864
Phone 773-710-6128
Authorized official
Kiran Polavarapu
Owner
8176158576
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