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Organization

POLAVARAPU PLASTIC SURGERY, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KIRAN POLAVARAPU M.D. (OWNER)
(817) 615-8576
Entity
Organization

Contact information

Practice address
4455 CAMP BOWIE BLVD, SUITE 114-30, FORT WORTH, TX 76107-3864
(773) 710-6128
Mailing address
4455 CAMP BOWIE BLVD, SUITE 114-30, FORT WORTH, TX 76107-3864
(773) 710-6128

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
Q0809
TX

Other

Enumeration date
12/05/2016
Last updated
01/31/2017
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