Provider Demographics
NPI:1225251424
Name:SUBURBAN PLASTIC SURGERY, S.C.
Entity Type:Organization
Organization Name:SUBURBAN PLASTIC SURGERY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMASAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIMUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-8222
Mailing Address - Street 1:5346 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2452
Mailing Address - Country:US
Mailing Address - Phone:708-636-8222
Mailing Address - Fax:708-636-9798
Practice Address - Street 1:5346 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2452
Practice Address - Country:US
Practice Address - Phone:708-636-8222
Practice Address - Fax:708-636-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL553050Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER