Provider Demographics
NPI:1780858373
Name:ORLAND PARK PLASTIC SURGERY, S.C.
Entity Type:Organization
Organization Name:ORLAND PARK PLASTIC SURGERY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MANOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-873-9600
Mailing Address - Street 1:8760 W 159TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5395
Mailing Address - Country:US
Mailing Address - Phone:708-873-9600
Mailing Address - Fax:708-873-9607
Practice Address - Street 1:8760 W 159TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5395
Practice Address - Country:US
Practice Address - Phone:708-873-9600
Practice Address - Fax:708-873-9607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORLAND PARK PLASTIC SURGERY, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-15
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360931682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093168Medicaid
IL209502Medicare PIN