Organization
CALISOMA COSMETIC SURGERY INSTITUTE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGIE ROSANNE TARAS MD (PRESIDENT)
(312) 659-8005
Entity
Organization
Contact information
Practice address
1460 MARKET ST, DES PLAINES, IL 60016-4643
(312) 659-8005
Mailing address
2760 WYNFIELD LN, BROOKFIELD, WI 53045-3352
(312) 659-8005
(815) 462-4955
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036129138
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201083390A
—
IN
Enumeration date
07/29/2014
Last updated
07/20/2015
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