Provider Demographics
NPI:1922781673
Name:SUBURBAN MEDICAL AESTHETICS, PLLC
Entity Type:Organization
Organization Name:SUBURBAN MEDICAL AESTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-424-1100
Mailing Address - Street 1:500 DAVIS ST STE 810
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4655
Mailing Address - Country:US
Mailing Address - Phone:847-424-1100
Mailing Address - Fax:847-448-0201
Practice Address - Street 1:500 DAVIS ST STE 810
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4655
Practice Address - Country:US
Practice Address - Phone:847-424-1100
Practice Address - Fax:847-448-0201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUBURBAN EYES CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty