Provider Demographics
NPI:1245346923
Name:AESTHETIC PLASTIC SURGERY INSTITUTE OF LOUISVILLE, LLC
Entity type:Organization
Organization Name:AESTHETIC PLASTIC SURGERY INSTITUTE OF LOUISVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CHARIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-568-4800
Mailing Address - Street 1:444 S 1ST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1416
Mailing Address - Country:US
Mailing Address - Phone:502-238-2888
Mailing Address - Fax:502-238-2897
Practice Address - Street 1:444 S 1ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1416
Practice Address - Country:US
Practice Address - Phone:502-238-2888
Practice Address - Fax:502-238-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300168261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50006214OtherPASSPORT
KY36001360Medicaid
KY000000357022OtherANTHEM
KY36001360Medicaid