Organization
RENAISSANCE PLASTIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH J FATA (OWNER)
(317) 575-9152
Entity
Organization
Contact information
Practice address
10293 N MERIDIAN ST, SUITE 200, INDPLS, IN 46290
(317) 575-9152
(317) 575-9281
Mailing address
10293 N MERIDIAN ST, SUITE 200, INDPLS, IN 46290
(317) 575-9152
(317) 575-9281
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100120400A
—
IN
Enumeration date
12/04/2006
Last updated
06/27/2013
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