| NPI | 1093152118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT D CARTER Manager 815-977-4403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: IL 036124349) |
| Additional Taxonomies | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2025-08-12 |