Organization
CENTER FOR COSMETIC MEDICINE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STUART F. BAKER M.D. (PRESIDENT)
(217) 877-9000
Entity
Organization
Contact information
Practice address
2 MEMORIAL DR STE 310, DECATUR, IL 62526-3983
(217) 877-9000
(217) 877-9615
Mailing address
2 MEMORIAL DR STE 310, DECATUR, IL 62526-3983
(217) 877-9000
(217) 877-9615
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036060776
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060776
—
IL
Enumeration date
05/16/2007
Last updated
10/17/2013
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