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Organization
ALLOPLASTIC RECONSTRUCTION
Active
Organization
ALLOPLASTIC RECONSTRUCTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL KACZKOWSKI (PRESIDENT)
(501) 265-0100
Entity
Organization
Contact information
Practice address
3924 W MARKHAM ST, LITTLE ROCK, AR 72205-5528
(501) 265-0100
(501) 265-0102
Mailing address
3924 W MARKHAM ST, LITTLE ROCK, AR 72205-5528
(501) 265-0100
(501) 265-0102
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
NULL
156FX1700X
Ocularist
Primary
—
—
174400000X
Specialist
—
NULL
174400000X
Specialist
—
—
229N00000X
Anaplastologist
—
NULL
229N00000X
Anaplastologist
—
—
332BC3200X
Customized Equipment (DME)
—
NULL
335E00000X
Prosthetic/Orthotic Supplier
OPP00038
AR
Other
Enumeration date
10/06/2011
Last updated
09/26/2018
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