Provider Demographics
NPI:1649291014
Name:CHICAGO CENTER FOR FACIAL PLASTIC SURGERY, S.C.
Entity type:Organization
Organization Name:CHICAGO CENTER FOR FACIAL PLASTIC SURGERY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-335-2070
Mailing Address - Street 1:PO BOX 388320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8320
Mailing Address - Country:US
Mailing Address - Phone:773-767-4600
Mailing Address - Fax:773-767-8320
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:9TH FLOOR EAST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-335-2070
Practice Address - Fax:312-335-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622973OtherBLUE SHIELD
040015132OtherRAILROAD MEDICARE
040015132OtherRAILROAD MEDICARE