Provider Demographics
NPI:1447282249
Name:CENTRAL KENTUCKY PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:CENTRAL KENTUCKY PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-236-1670
Mailing Address - Street 1:230 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1871
Mailing Address - Country:US
Mailing Address - Phone:859-236-1670
Mailing Address - Fax:859-236-1672
Practice Address - Street 1:230 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1871
Practice Address - Country:US
Practice Address - Phone:859-236-1670
Practice Address - Fax:859-236-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty