Provider Demographics
NPI:1710250089
Name:CHARMING SKIN MED SPA SC
Entity Type:Organization
Organization Name:CHARMING SKIN MED SPA SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAWDAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-974-4270
Mailing Address - Street 1:2425 W 22ND ST STE 216
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4662
Mailing Address - Country:US
Mailing Address - Phone:708-974-4270
Mailing Address - Fax:888-466-3320
Practice Address - Street 1:2425 W 22ND ST STE 216
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4662
Practice Address - Country:US
Practice Address - Phone:708-974-4270
Practice Address - Fax:888-466-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087208Medicaid
IL036087208Medicaid
IL369700Medicare PIN