Organization
RENAISSANCE PLASTIC SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL M TKACH M.D. (OWNER)
(270) 444-8200
Entity
Organization
Contact information
Practice address
2601 KENTUCKY AVE, STE 401, PADUCAH, KY 42003-3827
(270) 444-8200
(270) 444-8398
Mailing address
2601 KENTUCKY AVE, STE 401, PADUCAH, KY 42003
(270) 444-8200
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65907685
—
KY
Enumeration date
07/22/2006
Last updated
12/03/2010
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