Provider Demographics
NPI:1306079298
Name:NORTHWESTERN SPECIALISTS IN PLASTIC SURGERY, S.C.
Entity type:Organization
Organization Name:NORTHWESTERN SPECIALISTS IN PLASTIC SURGERY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-266-6240
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:1575
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-266-6240
Mailing Address - Fax:312-266-1411
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:1525A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-266-6240
Practice Address - Fax:312-266-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-049906208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH80000Medicare UPIN