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General NPI Number Information
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NPI Number | 1245917038
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Entity Type | Organization
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Legal Business Name | PRISM PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 2845 N. SHERIDAN RD STE 903
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City | CHICAGO
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State | IL
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Zip | 60657
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Country | US
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Telephone | 312-872-8514
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Fax |
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Provider Business Mailing Address
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Address Line | 2517 W SHAKESPEARE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4117
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Country | US
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Telephone | 847-507-7077
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMEER KAPADIA
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Credential | MD
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Telephone | 847-507-7707
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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 |
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