# GOLD COAST PLASTIC SURGERY LLC

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

## Provider details

- **NPI number:** 1821268772
- **Authorized official:** MARY G. FORDE (OFFICE MANAGER)
- **Authorized official phone:** (312) 988-9300

## Contact information

- **Practice address:** 1 E ERIE ST, SUITE 640, CHICAGO, IL 60611-2740
- **Practice address phone:** (312) 988-9300
- **Practice address fax:** (312) 988-9310
- **Mailing address:** 1 E ERIE ST, SUITE 640, CHICAGO, IL 60611-2740
- **Mailing address phone:** (312) 988-9300
- **Mailing address fax:** (312) 988-9310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | 036104040 | IL | Yes |

## Other

- **Enumeration date:** 03/06/2008
- **Last updated:** 01/06/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1548342355 | NPI | IL |
| 01 | — | H92062 | UPIN | — |