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General NPI Number Information
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NPI Number | 1619025350
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY SPECIALISTS OF ILLINOIS SC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 20635 ABBEY WOODS CT N SUITE 202
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City | FRANKFORT
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State | IL
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Zip | 60423-3181
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Country | US
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Telephone | 815-806-9400
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Fax | 815-806-9550
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Provider Business Mailing Address
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Address Line | 20635 ABBEY WOODS CT N SUITE 202
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City | FRANKFORT
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State | IL
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Zip | 60423-3181
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Country | US
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Telephone | 815-806-9400
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Fax | 815-806-9550
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAREN WELKE
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Credential |
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Telephone | 815-806-9400
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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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