Provider Demographics
NPI:1982726121
Name:AESTHETIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:AESTHETIC SURGERY ASSOCIATES
Other - Org Name:CENTER FOR COSMETIC AND LASER SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-851-3223
Mailing Address - Street 1:4425 MONTGOMERY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9542
Mailing Address - Country:US
Mailing Address - Phone:630-851-3223
Mailing Address - Fax:630-820-8619
Practice Address - Street 1:4425 MONTGOMERY RD STE 102
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9542
Practice Address - Country:US
Practice Address - Phone:630-851-3223
Practice Address - Fax:630-820-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36091277261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL98217Medicare ID - Type Unspecified