MEDICARE: PLASTIC SURGERY CLINIC OF CHICAGO LLC

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
1	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1821501586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC SURGERY CLINIC OF CHICAGO LLC

Provider Business Mailing Address
First Line	:	850 S WABASH AVE STE 310
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3642
Country	:	US
Telephone Number	:	419-656-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 S WABASH AVE STE 310
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3642
Country	:	US
Telephone Number	:	419-656-6863
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	PARIT PATEL
Credential	:	MD
Telephone Number	:	419-656-6863

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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