MEDICARE: CENTER OF EXCELLENCE IN PLASTIC, AESTHETIC, AND RECONSTRUCTIVE SURGERY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1356293906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER OF EXCELLENCE IN PLASTIC, AESTHETIC, AND RECONSTRUCTIVE SURGERY, INC.

Provider Business Mailing Address
First Line	:	152 W HURON ST UNIT 500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7384
Country	:	US
Telephone Number	:	312-371-4248
Fax Number	:	312-284-1030

Provider Business Practice Location Address
First Line	:	1310 E SAMUEL AVE APT 3D
Second Line	:
City	:	PEORIA HEIGHTS
State	:	IL
Zip	:	61616-6497
Country	:	US
Telephone Number	:	312-371-4248
Fax Number	:	312-284-1030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMIR H DORAFSHAR
Credential	:	MD
Telephone Number	:	312-371-4248

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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