Provider Demographics
NPI:1427097856
Name:GRASSESCHI RECONSTRUCTIVE & PLASTIC SURGERY
Entity type:Organization
Organization Name:GRASSESCHI RECONSTRUCTIVE & PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GRASSESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-328-2277
Mailing Address - Street 1:2500 RIDGE AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2455
Mailing Address - Country:US
Mailing Address - Phone:847-328-2277
Mailing Address - Fax:847-328-8591
Practice Address - Street 1:2500 RIDGE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2455
Practice Address - Country:US
Practice Address - Phone:847-328-2277
Practice Address - Fax:847-328-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360478951Medicaid
IL21608613OtherBLUE CROSS BLUE SHIELD
IL21608613OtherBLUE CROSS BLUE SHIELD
IL642500Medicare ID - Type UnspecifiedMEDICARE