Organization
PREMIER MEDICAL GROUP, LLC
Active
Other names
Center for Cosmetic and Laser Surgery, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HESSE (EXECUTIVE ADMINISTRATOR)
(309) 662-6200
Entity
Organization
Contact information
Practice address
1505 EASTLAND DR, SUITE 350, BLOOMINGTON, IL 61701-3534
(309) 663-1222
(309) 663-0580
Mailing address
1505 EASTLAND DR, SUITE 350, BLOOMINGTON, IL 61701-3534
(309) 663-1222
(309) 663-0580
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
36-084126
IL
Other
Enumeration date
03/30/2011
Last updated
03/30/2011
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