Renaissance Plastic Surgery PLLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

RENAISSANCE PLASTIC SURGERY PLLC

Practice address

2601 Kentucky Ave
Ste 401
Paducah, KY 42003-3827

Phone

(270) 444-8200

Fax

(270) 444-8398

NPI assigned

Jul 22, 2006

Last updated

Dec 3, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Daniel M Tkach, M.D.NPI 1164441275

Title

Owner

Phone

(270) 444-8200

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel M Tkach, M.D.

  • Plastic Surgery Physician
  • Paducah, KY
  • NPI 1164441275
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291334400000",
    "number": "1154342350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 KENTUCKY AVE",
            "address_2": "STE 401",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "42003",
            "telephone_number": "270-444-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 KENTUCKY AVE",
            "address_2": "STE 401",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420033827",
            "telephone_number": "270-444-8200",
            "fax_number": "270-444-8398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE PLASTIC SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2010-12-03",
        "status": "A",
        "authorized_official_last_name": "TKACH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-444-8200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgery of the Hand",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65907685",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Paducah, KY
• Providers in Paducah, KY by specialty
• Plastic Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.