Provider Demographics
NPI:1104005776
Name:UNIVERSITY PLASTIC SURGEONS, INC.
Entity type:Organization
Organization Name:UNIVERSITY PLASTIC SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:STROUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-219-5555
Mailing Address - Street 1:13660 BRAEBURN LN
Mailing Address - Street 2:
Mailing Address - City:NOVELTY
Mailing Address - State:OH
Mailing Address - Zip Code:44072-9597
Mailing Address - Country:US
Mailing Address - Phone:216-219-5555
Mailing Address - Fax:
Practice Address - Street 1:13660 BRAEBURN LN
Practice Address - Street 2:
Practice Address - City:NOVELTY
Practice Address - State:OH
Practice Address - Zip Code:44072-9597
Practice Address - Country:US
Practice Address - Phone:216-219-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 059617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879081Medicaid
OH0801412Medicaid
OH0801412Medicaid
OHUN9249911Medicare PIN
OHE76474Medicare UPIN