Healthcare Provider Details

I. General information

NPI: 1194754861
Provider Name (Legal Business Name): ASSOCIATES FOR PLASTIC SURGERY EXCELLENCE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 GOLF RD SUITE 110
DES PLAINES IL
60016-1667
US

IV. Provider business mailing address

9301 GOLF RD SUITE 110
DES PLAINES IL
60016-1667
US

V. Phone/Fax

Practice location:
  • Phone: 847-297-8001
  • Fax: 847-297-8125
Mailing address:
  • Phone: 847-297-8001
  • Fax: 847-297-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MANSOUR VINCENT MAKHLOUF
Title or Position: PRESIDENT
Credential: MD
Phone: 847-297-8001