Provider Demographics
NPI:1194977447
Name:LOKEH PLASTIC SURGERY PA
Entity type:Organization
Organization Name:LOKEH PLASTIC SURGERY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:LANIE
Authorized Official - Suffix:
Authorized Official - Credentials:CST
Authorized Official - Phone:612-360-7700
Mailing Address - Street 1:3500 VICKSBURG LN N # 128
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1334
Mailing Address - Country:US
Mailing Address - Phone:612-360-7700
Mailing Address - Fax:763-479-3006
Practice Address - Street 1:15535 34TH AVE N # 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1481
Practice Address - Country:US
Practice Address - Phone:612-360-7700
Practice Address - Fax:763-479-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty