Provider Demographics
NPI:1861645178
Name:THE AESTHETIC PLASTIC SURGERY CENTER OF BARRINGTON, LLC
Entity Type:Organization
Organization Name:THE AESTHETIC PLASTIC SURGERY CENTER OF BARRINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BAZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-382-4160
Mailing Address - Street 1:20 EXECUTIVE CT
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9543
Mailing Address - Country:US
Mailing Address - Phone:847-382-4160
Mailing Address - Fax:
Practice Address - Street 1:20 EXECUTIVE CT
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9543
Practice Address - Country:US
Practice Address - Phone:847-382-4160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103581208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty