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Organization

ALLOPLASTIC FACIAL RECONSTRUCTION

Active
Other names
Alloplastic Reconstruction Inc
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL D 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
332BC3200X
Customized Equipment (DME)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02593066
NY
05
140207716
AR
01
49597
BCBS
AR
Enumeration date
11/28/2007
Last updated
10/02/2020
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