| NPI | 1790271096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANDICE KING Credentialing Specialist 847-228-3303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME136100) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2019-08-21 |