Healthcare Provider Details

I. General information

NPI: 1750285201
Provider Name (Legal Business Name): MACLEOD SURGERY AND AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 W EVERGREEN AVE UNIT 1
CHICAGO IL
60651-2419
US

IV. Provider business mailing address

3255 W EVERGREEN AVE UNIT 1
CHICAGO IL
60651-2419
US

V. Phone/Fax

Practice location:
  • Phone: 207-318-3279
  • Fax:
Mailing address:
  • Phone: 207-318-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRITTANY MACLEOD
Title or Position: FOUNDER
Credential: PA-C
Phone: 207-318-3279