Organization
SOUTHWEST AESTHETICS AND BODY SCULPTURE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE CHIU MD (MANAGER MEMBER)
(815) 545-9772
Entity
Organization
Contact information
Practice address
217 VERTIN BLVD, SHOREWOOD, IL 60404-8783
(815) 545-9772
Mailing address
PO BOX 11009, OLYMPIA, WA 98508-1009
(360) 352-2037
(360) 352-0637
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1371
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053917
—
IL
05
—
036065985
—
IL
05
—
036087434
—
IL
05
—
036088162
—
IL
01
—
DQ7598
RR MEDICARE PALMETTO GBA
IL
01
—
P00870409
RR MEDICARE PALMETTO GBA
IL
01
—
P00870505
RR MEDICARE PALMETTO GBA
IL
Enumeration date
03/13/2009
Last updated
02/18/2011
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