Provider Demographics
NPI:1396810982
Name:NAYAK PLASTIC SURGERY, P.C.
Entity type:Organization
Organization Name:NAYAK PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAXMEESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:NAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-991-5348
Mailing Address - Street 1:607 S LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2734
Mailing Address - Country:US
Mailing Address - Phone:314-991-5348
Mailing Address - Fax:314-991-2914
Practice Address - Street 1:607 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2734
Practice Address - Country:US
Practice Address - Phone:314-991-5348
Practice Address - Fax:314-991-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004004167207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO919274888Medicare PIN
MO000014888Medicare PIN