=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982426573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AESTHETIC CARE SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2024
-----------------------------------------------------
Last Update Date | 10/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9830 RIDGELAND AVE STE 2A
-----------------------------------------------------
City | CHICAGO RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60415-2668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-599-8000
-----------------------------------------------------
Fax | 708-599-8006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9830 RIDGELAND AVE STE 2
-----------------------------------------------------
City | CHICAGO RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60415-2668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-599-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. MOHAMAD JALAB
-----------------------------------------------------
Credential | FIRST SURGICAL ASSIS
-----------------------------------------------------
Telephone | 810-247-5373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------