| NPI | 1366676645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRVIN M WIESMAN President 773-275-5550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IL 036095961) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2015-11-06 |