# FACIAL PLASTIC & LASER SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Facial Plastic & Laser Surgery Center, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194888677
- **Authorized official:** MR. ROBERT J TUDOR II (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (309) 589-8053

## Contact information

- **Practice address:** 7301 N KNOXVILLE AVE, PEORIA, IL 61614-2017
- **Practice address phone:** (309) 589-3233
- **Practice address fax:** (309) 689-0312
- **Mailing address:** 7301 N KNOXVILLE AVE, PEORIA, IL 61614-2017
- **Mailing address phone:** (309) 589-3233
- **Mailing address fax:** (309) 689-0312

## Taxonomy

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

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 07/21/2022