# ALLOPLASTIC RECONSTRUCTION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598049744
- **Authorized official:** MR. MICHAEL KACZKOWSKI (PRESIDENT)
- **Authorized official phone:** (501) 265-0100

## Contact information

- **Practice address:** 3924 W MARKHAM ST, LITTLE ROCK, AR 72205-5528
- **Practice address phone:** (501) 265-0100
- **Practice address fax:** (501) 265-0102
- **Mailing address:** 3924 W MARKHAM ST, LITTLE ROCK, AR 72205-5528
- **Mailing address phone:** (501) 265-0100
- **Mailing address fax:** (501) 265-0102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1700X | Ocularist | — | NULL | Yes |
| 156FX1700X | Ocularist | — | — | Yes |
| 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