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General NPI Number Information
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NPI Number | 1235330325
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Entity Type | Organization
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Legal Business Name | JAY M PENSLER,MD,SC
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR SUITE 1125
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-642-7777
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Fax | 312-642-3333
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR SUITE 1125
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-642-7777
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Fax | 312-642-3333
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY MICHAEL PENSLER
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Credential | M.D.
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Telephone | 312-642-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State | IL
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