Provider Demographics
NPI:1306544291
Name:MAJESTIC AESTHETICS LLC
Entity type:Organization
Organization Name:MAJESTIC AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERVEUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:833-216-4500
Mailing Address - Street 1:5315 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3353
Mailing Address - Country:US
Mailing Address - Phone:833-216-4500
Mailing Address - Fax:
Practice Address - Street 1:5315 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3353
Practice Address - Country:US
Practice Address - Phone:833-216-4500
Practice Address - Fax:561-768-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical