Provider Demographics
NPI:1295284412
Name:PLASTIC SURGERY CHICAGO, LLC
Entity type:Organization
Organization Name:PLASTIC SURGERY CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-337-7795
Mailing Address - Street 1:60 E DELAWARE PL
Mailing Address - Street 2:#1430
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1495
Mailing Address - Country:US
Mailing Address - Phone:312-337-7795
Mailing Address - Fax:
Practice Address - Street 1:60 E DELAWARE PL
Practice Address - Street 2:#1430
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1495
Practice Address - Country:US
Practice Address - Phone:312-337-7795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36.087851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty