Northwestern Assoc in Aesthetic Plastic & Craniofacial Surgery SC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

042004549 Issued in IL

Legal business name

NORTHWESTERN ASSOC IN AESTHETIC PLASTIC & CRANIOFACIAL SURGERY SC

Practice address

150 E Huron St
Suite 825
Chicago, IL 60611-2999

Phone

(312) 335-9155

NPI assigned

May 14, 2007

Organization subpart

No

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

Authorized official

Name

Victor Lamar Lewis Jr.

Title

President

Phone

(312) 335-9155

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245110400000",
    "number": "1275748873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 E HURON ST",
            "address_2": "SUITE 825",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112999",
            "telephone_number": "312-335-9155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E HURON ST",
            "address_2": "SUITE 825",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112999",
            "telephone_number": "312-335-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN ASSOC IN AESTHETIC PLASTIC & CRANIOFACIAL SURGERY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2009-06-16",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "LAMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-335-9155",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "042004549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036042900",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Plastic and Reconstructive Surgery Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Plastic and Reconstructive Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; 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.