Provider Demographics
NPI:1487765277
Name:AESTHETIC PLASTIC & RECONSTRUCTIVE SURGERY SC
Entity type:Organization
Organization Name:AESTHETIC PLASTIC & RECONSTRUCTIVE SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAULIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-920-9404
Mailing Address - Street 1:120 E OGDEN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3542
Mailing Address - Country:US
Mailing Address - Phone:630-920-9404
Mailing Address - Fax:630-920-9447
Practice Address - Street 1:120 E OGDEN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3542
Practice Address - Country:US
Practice Address - Phone:630-920-9404
Practice Address - Fax:630-920-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106620208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94407Medicare UPIN
206983Medicare ID - Type Unspecified