Center for Cosmetic Medicine, LTD.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036060776 Issued in IL

Legal business name

CENTER FOR COSMETIC MEDICINE, LTD.

Practice address

2 Memorial Dr Ste 310
Decatur, IL 62526-3983

Phone

(217) 877-9000

Fax

(217) 877-9615

NPI assigned

May 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stuart F. Baker, M.D.

Title

President

Phone

(217) 877-9000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381968000000",
    "number": "1104033794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MEMORIAL DR STE 310",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263983",
            "telephone_number": "217-877-9000",
            "fax_number": "217-877-9615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEMORIAL DR STE 310",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263983",
            "telephone_number": "217-877-9000",
            "fax_number": "217-877-9615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR COSMETIC MEDICINE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2013-10-17",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "STUART",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-877-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036060776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036060776",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Decatur, IL
• Providers in Decatur, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.