Provider Demographics
NPI:1619025350
Name:PLASTIC SURGERY SPECIALISTS OF ILLINOIS SC
Entity Type:Organization
Organization Name:PLASTIC SURGERY SPECIALISTS OF ILLINOIS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-806-9400
Mailing Address - Street 1:20635 ABBEY WOODS CT N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3181
Mailing Address - Country:US
Mailing Address - Phone:815-806-9400
Mailing Address - Fax:815-806-9550
Practice Address - Street 1:20635 ABBEY WOODS CT N
Practice Address - Street 2:SUITE 202
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3181
Practice Address - Country:US
Practice Address - Phone:815-806-9400
Practice Address - Fax:815-806-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204831Medicare ID - Type Unspecified