Provider Demographics
NPI:1023133071
Name:PLASTIC SURGERY CONSULTANTS LTD
Entity type:Organization
Organization Name:PLASTIC SURGERY CONSULTANTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARSCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-462-6858
Mailing Address - Street 1:199 TOWN SQ
Mailing Address - Street 2:SUITE E
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-3878
Mailing Address - Country:US
Mailing Address - Phone:630-462-6858
Mailing Address - Fax:630-462-1013
Practice Address - Street 1:199 TOWN SQ
Practice Address - Street 2:SUITE E
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-3878
Practice Address - Country:US
Practice Address - Phone:630-462-6858
Practice Address - Fax:630-462-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071166207N00000X
IL036070575208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366670Medicare ID - Type Unspecified