Healthcare Provider Details

I. General information

NPI: 1922334226
Provider Name (Legal Business Name): THE CHICAGO CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 NORTH MICHIGAN AVENUE SUITE 980W
CHICAGO IL
60611-2218
US

IV. Provider business mailing address

845 NORTH MICHIGAN AVENUE SUITE 980W
CHICAGO IL
60611-2218
US

V. Phone/Fax

Practice location:
  • Phone: 312-642-0400
  • Fax: 312-642-0500
Mailing address:
  • Phone: 312-642-0400
  • Fax: 312-642-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY WEINZWEIG
Title or Position: DIRECTOR
Credential: M.D
Phone: 312-642-0400