Healthcare Provider Details

I. General information

NPI: 1568620144
Provider Name (Legal Business Name): HEALTH & RENEWAL PLASTIC SURGERY ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 MCCOY DR SUITE 101
AURORA IL
60504-4105
US

IV. Provider business mailing address

849 W OHIO ST UNIT 1
CHICAGO IL
60622-8901
US

V. Phone/Fax

Practice location:
  • Phone: 630-952-1400
  • Fax:
Mailing address:
  • Phone: 630-952-1400
  • Fax: 630-952-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK A GREVIOUS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-952-1400