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General NPI Number Information
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NPI Number | 1427097856
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Entity Type | Organization
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Legal Business Name | GRASSESCHI RECONSTRUCTIVE & PLASTIC SURGERY
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2500 RIDGE AVE SUITE 208
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City | EVANSTON
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State | IL
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Zip | 60201-2455
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Country | US
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Telephone | 847-328-2277
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Fax | 847-328-8591
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Provider Business Mailing Address
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Address Line | 2500 RIDGE AVE SUITE 208
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City | EVANSTON
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State | IL
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Zip | 60201-2455
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Country | US
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Telephone | 847-328-2277
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Fax | 847-328-8591
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Authorized Official
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Title or Position | OWNER
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Name | DR. MITCHELL FRANK GRASSESCHI
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Credential | M.D.
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Telephone | 847-328-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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