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Organization

PLASTIC AND RECONSTRUCTIVE SURGERY CENTER SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN A. KOTIS D.O. (CEO)
(847) 577-6400
Entity
Organization

Contact information

Practice address
3443 N KENNICOTT AVE, ARLINGTON HTS, IL 60004-1431
(847) 577-6400
(847) 577-3194
Mailing address
3443 N KENNICOTT AVE, ARLINGTON HTS, IL 60004-1431
(847) 577-6400
(847) 577-3194

Taxonomy

Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
Primary
036087458
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036087458
IL
Enumeration date
10/30/2010
Last updated
10/30/2010
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