Provider Demographics
NPI:1770721094
Name:UNIVERSITY PLASTIC SURGERY 1, LLC
Entity type:Organization
Organization Name:UNIVERSITY PLASTIC SURGERY 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-967-5122
Mailing Address - Street 1:9000 WAUKEGAN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2127
Mailing Address - Country:US
Mailing Address - Phone:847-967-5122
Mailing Address - Fax:847-967-5125
Practice Address - Street 1:9000 WAUKEGAN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2127
Practice Address - Country:US
Practice Address - Phone:847-967-5122
Practice Address - Fax:847-967-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty