Provider Demographics
NPI:1316353881
Name:MIDWEST PLASTIC SURGERY INSTITUTE, INC.
Entity type:Organization
Organization Name:MIDWEST PLASTIC SURGERY INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:JEJURIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-320-0045
Mailing Address - Street 1:3800 HIGHLAND AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1557
Mailing Address - Country:US
Mailing Address - Phone:630-960-0023
Mailing Address - Fax:630-960-4137
Practice Address - Street 1:3800 HIGHLAND AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1557
Practice Address - Country:US
Practice Address - Phone:630-960-0023
Practice Address - Fax:630-960-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088828208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty