Provider Demographics
NPI:1609101773
Name:OAK BROOK PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:OAK BROOK PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SAI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMASASTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-422-4180
Mailing Address - Street 1:5669 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2382
Mailing Address - Country:US
Mailing Address - Phone:708-422-4180
Mailing Address - Fax:
Practice Address - Street 1:5669 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2382
Practice Address - Country:US
Practice Address - Phone:708-422-4180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherUNITED HEALTH CARE