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General NPI Number Information
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NPI Number | 1932815123
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Entity Type | Organization
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Legal Business Name | GOLD COAST BARIATRICS LLC
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 04/08/2023
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Provider Practice Location Address
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Address Line | 2540 W CHICAGO AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60622-8365
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Country | US
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Telephone | 646-234-8943
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Fax |
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Provider Business Mailing Address
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Address Line | 456 E NORTH WATER ST UNIT G
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City | CHICAGO
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State | IL
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Zip | 60611-5510
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Country | US
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Telephone | 646-234-8943
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Fax | 888-981-5378
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHANDRA HASSAN
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Credential | MD
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Telephone | 646-234-8943
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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 |
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