Provider Demographics
NPI:1902467483
Name:CLINIC FOR PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:CLINIC FOR PLASTIC SURGERY PA
Other - Org Name:THE CLINIC FOR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-990-8487
Mailing Address - Street 1:1616 CLEAR LAKE CITY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14018 AESTHETIC CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2373
Practice Address - Country:US
Practice Address - Phone:281-990-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty