Provider Demographics
NPI:1497826903
Name:SUBURBAN PLASTIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:SUBURBAN PLASTIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-755-1000
Mailing Address - Street 1:1585 N BARRINGTON RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-755-1000
Mailing Address - Fax:847-755-1001
Practice Address - Street 1:1585 N BARRINGTON RD
Practice Address - Street 2:SUITE 601
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-755-1000
Practice Address - Fax:847-755-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL726580Medicare ID - Type UnspecifiedSUBURBAN PLASTIC SURGERY