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General NPI Number Information
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NPI Number | 1629333224
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Entity Type | Organization
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Legal Business Name | FLAWLESS SERVICE CORPORATION
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 2555 S KING DR 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60616-2419
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Country | US
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Telephone | 312-222-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 2555 S KING DR 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60616-2419
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Country | US
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Telephone | 312-222-0030
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. REGINA PORTER
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Credential | R.N.
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Telephone | 312-222-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | IL
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