Organization
GOLD COAST PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY G. FORDE (OFFICE MANAGER)
(312) 988-9300
Entity
Organization
Contact information
Practice address
1 E ERIE ST, SUITE 640, CHICAGO, IL 60611-2740
(312) 988-9300
(312) 988-9310
Mailing address
1 E ERIE ST, SUITE 640, CHICAGO, IL 60611-2740
(312) 988-9300
(312) 988-9310
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
036104040
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548342355
NPI
IL
01
—
H92062
UPIN
—
Enumeration date
03/06/2008
Last updated
01/06/2009
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