Provider Demographics
NPI:1912127952
Name:AESTHETIC & RECONSTRUCTIVE PLASTIC SURGERY INSTITUTE, S.C.
Entity Type:Organization
Organization Name:AESTHETIC & RECONSTRUCTIVE PLASTIC SURGERY INSTITUTE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-355-0992
Mailing Address - Street 1:6 BRONZE POINTE S
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8307
Mailing Address - Country:US
Mailing Address - Phone:618-355-0992
Mailing Address - Fax:
Practice Address - Street 1:6 BRONZE POINTE S
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8307
Practice Address - Country:US
Practice Address - Phone:618-355-0992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical