Organization
PHYSICIAN'S INSTITUTE OF COSMETIC AND RECONSTRUCTIVE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WANDA DITTHARDT (OFFICE MANAGER)
(954) 964-4113
Entity
Organization
Contact information
Practice address
3449 JOHNSON ST, HOLLYWOOD, FL 33021-5420
(954) 964-4113
(954) 963-8121
Mailing address
3449 JOHNSON ST, HOLLYWOOD, FL 33021-5420
(954) 964-4113
(954) 963-8121
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME62894
FL
174400000X
Specialist
ME64761
FL
Other
Enumeration date
06/12/2007
Last updated
08/22/2020
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