Provider Demographics
NPI:1528678026
Name:SPECTRUM PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:SPECTRUM PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SENCHENKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-398-2753
Mailing Address - Street 1:PO BOX 3612
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-3612
Mailing Address - Country:US
Mailing Address - Phone:507-398-2753
Mailing Address - Fax:941-866-9024
Practice Address - Street 1:2426 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3842
Practice Address - Country:US
Practice Address - Phone:507-398-2753
Practice Address - Fax:941-866-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-09
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty