Polavarapu Plastic Surgery, PLLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

Q0809 Issued in TX

Legal business name

POLAVARAPU PLASTIC SURGERY, PLLC

Practice address

4455 Camp Bowie Blvd
Suite 114-30
Fort Worth, TX 76107-3864

Phone

(773) 710-6128

NPI assigned

Dec 5, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Kiran Polavarapu, M.D.NPI 1518139518

Title

Owner

Phone

(817) 615-8576

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kiran Polavarapu, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Burleson, TX
  • NPI 1518139518
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485820800000",
    "number": "1982148326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 CAMP BOWIE BLVD",
            "address_2": "SUITE 114-30",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761073864",
            "telephone_number": "773-710-6128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 CAMP BOWIE BLVD",
            "address_2": "SUITE 114-30",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761073864",
            "telephone_number": "773-710-6128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLAVARAPU PLASTIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-05",
        "last_updated": "2017-01-31",
        "status": "A",
        "authorized_official_last_name": "POLAVARAPU",
        "authorized_official_first_name": "KIRAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-615-8576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "Q0809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kushum Pokharel, NP-C
• Fijula Pokkasrakath, MD
• Alexa Ann Pokluda, MPAS, PA-C
• Winifred Pokuaa
• Katharine Poland, DAT, ATC, LAT
• Elizabeth M Polizzi, LCSW
• Daniel Polk
• Freddie M Polk, LVN
• Kathleen E Pollan, PT
• Haley Pollard

• Plastic Surgery Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Plastic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.