Provider Demographics
NPI:1871724500
Name:OMNIVERSE PLASTIKOS PA
Entity type:Organization
Organization Name:OMNIVERSE PLASTIKOS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNO
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SCHLEICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-824-1492
Mailing Address - Street 1:1888 MAIN ST
Mailing Address - Street 2:SUITE C, #272
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6337
Mailing Address - Country:US
Mailing Address - Phone:601-824-1492
Mailing Address - Fax:
Practice Address - Street 1:14 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4190
Practice Address - Country:US
Practice Address - Phone:601-824-1492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS200232082S0099X, 2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty