Provider Demographics
NPI:1558330811
Name:HEAD & NECK COSMETIC SURGERY ASSOCIATES LLC
Entity Type:Organization
Organization Name:HEAD & NECK COSMETIC SURGERY ASSOCIATES LLC
Other - Org Name:HEAD & NECK AND COSMETIC SURGERY ASSOCIATES LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-296-5500
Mailing Address - Street 1:PO BOX 809094
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9094
Mailing Address - Country:US
Mailing Address - Phone:847-676-0091
Mailing Address - Fax:312-236-5162
Practice Address - Street 1:8930 GROSS POINT RD STE 700
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:773-262-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087798207K00000X
IL036047479207Y00000X, 207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCC4902OtherRAILROAD MEDICARE
IL01623471OtherBLUE CROSS BLUE SHIELD
604670Medicare PIN