Individual
JOHN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.F.A.C.S.
Contact information
Practice address
3612 LAKE AVE, SUITE 2A, WILMETTE, IL 60091-1000
(847) 251-3700
(847) 251-3798
Mailing address
3612 LAKE AVE, SUITE 2A, WILMETTE, IL 60091-1000
(847) 251-3700
(847) 251-3798
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036-042229
IL
Other
Enumeration date
11/14/2007
Last updated
11/14/2007
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