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General NPI Number Information
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NPI Number | 1275748873
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN ASSOC IN AESTHETIC PLASTIC & CRANIOFACIAL SURGERY SC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 150 E HURON ST SUITE 825
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City | CHICAGO
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State | IL
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Zip | 60611-2999
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Country | US
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Telephone | 312-335-9155
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E HURON ST SUITE 825
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City | CHICAGO
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State | IL
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Zip | 60611-2999
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Country | US
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Telephone | 312-335-9155
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICTOR LAMAR LEWIS JR.
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Credential |
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Telephone | 312-335-9155
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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 | 042004549
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License Number State | IL
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