Provider Demographics
NPI:1861585390
Name:FENDON PLASTIC SURGERY SC
Entity type:Organization
Organization Name:FENDON PLASTIC SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:FENDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-531-6340
Mailing Address - Street 1:1435 N. RANDALL ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-531-6340
Mailing Address - Fax:847-531-6344
Practice Address - Street 1:1435 N. RANDALL ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-531-6340
Practice Address - Fax:847-531-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360746992086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty