Provider Demographics
NPI:1619724366
Name:ADVANCED SURGICAL RECONSTRUCTION IN
Entity type:Organization
Organization Name:ADVANCED SURGICAL RECONSTRUCTION IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GIORGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-224-0555
Mailing Address - Street 1:110 WASHINGTON AVE APT 1623
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-7224
Mailing Address - Country:US
Mailing Address - Phone:954-224-0555
Mailing Address - Fax:954-840-8254
Practice Address - Street 1:110 WASHINGTON AVE APT 1623
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-7224
Practice Address - Country:US
Practice Address - Phone:954-224-0555
Practice Address - Fax:954-840-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty