Organization
MIDWEST PLASTIC& RECONSTRUCTIVE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRDJAN OSTRIC (PRESIDENT)
(312) 375-2076
Entity
Organization
Contact information
Practice address
5645 W ADDISON ST, CHICAGO, IL 60634-4403
(847) 729-4879
(773) 527-5070
Mailing address
801 WINDSOR RD, GLENVIEW, IL 60025-3128
(773) 527-5071
(773) 527-5070
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036107060
IL
2086S0105X
Surgery of the Hand (Surgery) Physician
036107060
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
036107060
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-107060
—
IL
Enumeration date
04/07/2008
Last updated
07/21/2008
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