Provider Demographics
NPI:1538860408
Name:PARK PLACE PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:PARK PLACE PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-980-2525
Mailing Address - Street 1:26 DI LUSSO DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-4703
Mailing Address - Country:US
Mailing Address - Phone:913-980-2525
Mailing Address - Fax:
Practice Address - Street 1:26 DI LUSSO DR
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-4703
Practice Address - Country:US
Practice Address - Phone:913-980-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty