# NORTH SHORE CENTER FOR FACIAL PLASTIC AND COSMETIC SURGERY

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

## Provider details

- **NPI number:** 1477851343
- **Authorized official:** DR. ANTHONY J GEROULIS M.D. (MEDICAL DIRECTOR PRESIDENT)
- **Authorized official phone:** (847) 441-4441

## Contact information

- **Practice address:** 330 W FRONTAGE RD, NORTHFIELD, IL 60093-3467
- **Practice address phone:** (847) 441-4441
- **Practice address fax:** (847) 784-9744
- **Mailing address:** 330 W FRONTAGE RD, NORTHFIELD, IL 60093-3467
- **Mailing address phone:** (847) 441-4441
- **Mailing address fax:** (847) 784-9744

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 036050050 | IL | Yes |

## Other

- **Enumeration date:** 03/02/2011
- **Last updated:** 11/24/2015