Organization
MIDWAY COSMETIC INSTITUTE, LLC
Active
Other names
63 Laser & Skin Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
AMIN MASHOUF (MANAGER)
(773) 284-9660
Entity
Organization
Contact information
Practice address
3918 W 63RD ST, CHICAGO, IL 60629-4604
(773) 284-9660
(773) 284-9676
Mailing address
PO BOX 11232, CHICAGO, IL 60629-4604
(773) 284-9660
(773) 284-9676
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
08/26/2014
Last updated
03/10/2015
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