Healthcare Provider Details

I. General information

NPI: 1124936414
Provider Name (Legal Business Name): GEORGE SIU TING HO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

500 N LAKE SHORE DR APT 2505
CHICAGO IL
60611-4586
US

V. Phone/Fax

Practice location:
  • Phone: 312-404-1797
  • Fax:
Mailing address:
  • Phone: 312-404-1797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number125089012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: