| NPI | 1942494273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J DOUGLAS CUSICK Owner 913-661-9537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MO 100181) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2021-03-11 |