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General NPI Number Information
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NPI Number | 1487765277
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Entity Type | Organization
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Legal Business Name | AESTHETIC PLASTIC & RECONSTRUCTIVE SURGERY SC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 120 E OGDEN AVE SUITE 204
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City | HINSDALE
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State | IL
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Zip | 60521-3542
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Country | US
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Telephone | 630-920-9404
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Fax | 630-920-9447
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Provider Business Mailing Address
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Address Line | 120 E OGDEN AVE SUITE 204
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City | HINSDALE
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State | IL
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Zip | 60521-3542
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Country | US
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Telephone | 630-920-9404
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Fax | 630-920-9447
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEXANDRINA S SAULIS
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Credential | MD
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Telephone | 630-920-9404
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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 | 036106620
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License Number State | IL
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