Provider Demographics
NPI:1992731228
Name:GT PLASTIC AND RECONSTRUCTIVE SURGERY, S.C.
Entity type:Organization
Organization Name:GT PLASTIC AND RECONSTRUCTIVE SURGERY, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUNNAR
Authorized Official - Middle Name:
Authorized Official - Last Name:THORS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-458-8808
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60011-0410
Mailing Address - Country:US
Mailing Address - Phone:847-458-8808
Mailing Address - Fax:847-458-8822
Practice Address - Street 1:163 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5551
Practice Address - Country:US
Practice Address - Phone:847-458-8808
Practice Address - Fax:847-458-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-6168882086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04923242OtherBLUECROSS/BLUESHIELD
132503800OtherUS DEPT OF LABOR-OWCP
132503800OtherUS DEPT OF LABOR-OWCP
213892Medicare ID - Type Unspecified
213891Medicare ID - Type Unspecified