Provider Demographics
NPI:1861017899
Name:LASER TRIM CORP
Entity Type:Organization
Organization Name:LASER TRIM CORP
Other - Org Name:TRIM BODY SCULPTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:PUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-908-9509
Mailing Address - Street 1:2863 95TH ST STE 225
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9005
Mailing Address - Country:US
Mailing Address - Phone:630-908-9509
Mailing Address - Fax:404-341-5463
Practice Address - Street 1:6100 LAKE FORREST DR STE 125
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3882
Practice Address - Country:US
Practice Address - Phone:404-937-6126
Practice Address - Fax:404-341-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty