Provider Demographics
NPI:1225619588
Name:NORTH SHORE FAMILY PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:NORTH SHORE FAMILY PLASTIC SURGERY LLC
Other - Org Name:S.A.R.A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:RATH
Authorized Official - Last Name:DICKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-920-8122
Mailing Address - Street 1:9000 WAUKEGAN RD STE 130
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2128
Mailing Address - Country:US
Mailing Address - Phone:847-820-9122
Mailing Address - Fax:
Practice Address - Street 1:9000 WAUKEGAN RD STE 130
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2128
Practice Address - Country:US
Practice Address - Phone:847-820-9122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty