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NPI Code Detail

MEDICARE: AESTHETIC INSTITUTE OF CHICAGO, S.C.

MEDICARE: AESTHETIC INSTITUTE OF CHICAGO, S.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0122XPlastic and Reconstructive Surgery Physician036096170IL

General Provider Information

NPI Number : 1306074521
Entity Type Code : Organization
Provider Name (Legal Business Name) : AESTHETIC INSTITUTE OF CHICAGO, S.C.
Provider Business Mailing Address
First Line : 601 W RANDOLPH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60661-2232
Country : US
Telephone Number : 312-258-9100
Fax Number : 312-258-1219
Provider Business Practice Location Address
First Line : 601 W RANDOLPH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60661-2232
Country : US
Telephone Number : 312-258-9100
Fax Number : 312-258-1219
Authorized Official
Title or Position : PRESIDENT
Name : BRIAN MICHAEL BRAITHWAITE
Credential : M.D.
Telephone Number : 312-258-9100
Provider Enumeration Date : 06/25/2009
Last Update Date : 03/19/2010

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Directions to “AESTHETIC INSTITUTE OF CHICAGO, S.C. ” Practice Location

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