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Organization
ANTI AGING SURGICAL CENTER
Active
Organization
ANTI AGING SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANIN MOSHIRI (MEDICAL DIRECTOR/OWN)
(773) 284-9660
Entity
Organization
Contact information
Practice address
3918 W 63RD ST, CHICAGO, IL 60629-4604
(773) 284-9660
Mailing address
PO BOX 11232, CHICAGO, IL 60611
(773) 284-9660
(773) 284-9676
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
60011238
IL
Other
Enumeration date
06/05/2009
Last updated
08/06/2015
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