Organization
ORLAND PARK PLASTIC SURGERY, S.C.
Active
Parent organization
ORLAND PARK PLASTIC SURGERY, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORLAND PARK PLASTIC SURGERY, S.C.
Authorized official
DR. EVAN T. MANOLIS M.D. (PRESIDENT)
(708) 873-9600
Entity
Organization
Contact information
Practice address
8760 W 159TH ST, SUITE 204, ORLAND PARK, IL 60462-5395
(708) 873-9600
(708) 873-9607
Mailing address
8760 W 159TH ST, SUITE 204, ORLAND PARK, IL 60462-5395
(708) 873-9600
(708) 873-9607
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
036093168
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093168
—
IL
Enumeration date
04/15/2008
Last updated
11/08/2011
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