# PARK RIDGE CENTER FOR PLASTIC SURGERY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043427826
- **Authorized official:** DR. SAM SPERON MD (DOCTOR)
- **Authorized official phone:** (847) 696-9900

## Contact information

- **Practice address:** 444 N. NORTHWEST HWY, PARK RIDGE, IL 60068
- **Practice address phone:** (847) 696-9900
- **Practice address fax:** (847) 696-9913
- **Mailing address:** 444 N. NORTHWEST HWY, PARK RIDGE, IL 60068
- **Mailing address phone:** (847) 696-9900
- **Mailing address fax:** (847) 696-9913

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036093576 | IL | Yes |

## Other

- **Enumeration date:** 05/17/2007
- **Last updated:** 04/07/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036093576 | — | IL |