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General NPI Number Information
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NPI Number | 1922781673
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Entity Type | Organization
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Legal Business Name | SUBURBAN MEDICAL AESTHETICS, PLLC
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 500 DAVIS ST STE 810
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City | EVANSTON
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State | IL
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Zip | 60201-4655
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Country | US
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Telephone | 847-424-1100
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Fax | 847-448-0201
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Provider Business Mailing Address
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Address Line | 500 DAVIS ST STE 810
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City | EVANSTON
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State | IL
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Zip | 60201-4655
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Country | US
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Telephone | 847-424-1100
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Fax | 847-448-0201
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. PHILLIP C. WU
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Credential | M.D.
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Telephone | 847-424-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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