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General NPI Number Information
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NPI Number | 1225320815
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Entity Type | Organization
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Legal Business Name | FLAWLESS, S.C.
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Dates
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Enumeration Date | 05/14/2011
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Last Update Date | 05/14/2011
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Provider Practice Location Address
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Address Line | 8222 S KING DR
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City | CHICAGO
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State | IL
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Zip | 60619-4964
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Country | US
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Telephone | 312-222-0030
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Fax | 773-873-4060
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Provider Business Mailing Address
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Address Line | PO BOX 804193
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City | CHICAGO
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State | IL
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Zip | 60680-4103
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Country | US
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Telephone | 312-222-0030
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ELTON X TINSLEY
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Credential | M.D.
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Telephone | 312-222-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036079325
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License Number State | IL
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