Provider Demographics
NPI:1245917038
Name:PRISM PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:PRISM PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-507-7707
Mailing Address - Street 1:2517 W SHAKESPEARE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4117
Mailing Address - Country:US
Mailing Address - Phone:847-507-7077
Mailing Address - Fax:
Practice Address - Street 1:2845 N. SHERIDAN RD
Practice Address - Street 2:STE 903
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:312-872-8514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty