Organization
ADVANCED FACIAL PLASTICS & MOHS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY MACMURCHY (CONTRACTING AND CREDENTIALING)
(815) 484-9900
Entity
Organization
Contact information
Practice address
1235 N MULFORD RD, SUITE 100, ROCKFORD, IL 61107-3879
(815) 484-9900
Mailing address
1235 N MULFORD RD, SUITE 100, ROCKFORD, IL 61107-3879
(815) 484-9900
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
IL
208200000X
Plastic Surgery Physician
—
IL
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
IL
Other
Enumeration date
09/28/2007
Last updated
11/08/2007
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