Healthcare Provider Details

I. General information

NPI: 1366502551
Provider Name (Legal Business Name): NORTHBROOK PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 LAKE COOK RD
NORTHBROOK IL
60062-1447
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 847-205-1680
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-471-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL EPSTEIN
Title or Position: OWNER
Credential: M.D.
Phone: 847-205-1680