Provider Demographics
NPI:1700188356
Name:DR. SPERON PLASTIC SURGERY, S.C.
Entity Type:Organization
Organization Name:DR. SPERON PLASTIC SURGERY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-696-9900
Mailing Address - Street 1:950 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2301
Mailing Address - Country:US
Mailing Address - Phone:847-696-9900
Mailing Address - Fax:847-696-9913
Practice Address - Street 1:950 N NORTHWEST HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2301
Practice Address - Country:US
Practice Address - Phone:847-696-9900
Practice Address - Fax:847-696-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093576208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty