Organization
FACIAL PLASTIC SURGERY EARS, NOSE, AND THROAT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BANIPAL HOVHANESSIAN MD (DR./OWNER)
(765) 455-2577
Entity
Organization
Contact information
Practice address
2220 W ALTO RD, KOKOMO, IN 46902-4840
(765) 455-2577
Mailing address
2220 W ALTO RD, KOKOMO, IN 46902-4840
(765) 455-2577
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087718
BLUE CROSS
IN
Enumeration date
08/30/2007
Last updated
08/30/2007
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