Provider Demographics
NPI:1821501586
Name:PLASTIC SURGERY CLINIC OF CHICAGO LLC
Entity Type:Organization
Organization Name:PLASTIC SURGERY CLINIC OF CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PARIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-656-6863
Mailing Address - Street 1:850 S WABASH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3642
Mailing Address - Country:US
Mailing Address - Phone:419-656-6863
Mailing Address - Fax:
Practice Address - Street 1:850 S WABASH AVE STE 310
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3642
Practice Address - Country:US
Practice Address - Phone:419-656-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty