Fenner Plastic Surgery, LTD.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

036081864 Issued in IL

Legal business name

FENNER PLASTIC SURGERY, LTD.

Practice address

512 Green Bay Rd
Kenilworth, IL 60043-1073

Phone

(847) 716-2400

Fax

(847) 716-2401

NPI assigned

Aug 22, 2008

Last updated

Oct 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Geoffrey Craig Fenner, M.D.NPI 1629176003

Title

Physician/Owner

Phone

(847) 716-2400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Geoffrey C Fenner, MD

  • Plastic Surgery Physician
  • Kenilworth, IL
  • NPI 1629176003
  Medicare reassignment NPD Authorized official
• Claire Soch, PA

  • Physician Assistant
  • Kenilworth, IL
  • NPI 1447031133
  Medicare reassignment
• Philip B Dray, M.D.

  • Ophthalmology Physician
  • Chicago, IL
  • NPI 1497748438
  NPD (past)
• Liad Ganz Pearlman, OD

  • Optometrist
  • Chicago, IL
  • NPI 1972876076
  NPD (past)
• Taylor Lintner, PA-C

  • Medical Physician Assistant
  • Northbrook, IL
  • NPI 1215712583
  NPD (past)
• Vandana Patel, O.D.

  • Optometrist
  • Chicago, IL
  • NPI 1912159591
  NPD (past)
• Julie Beth Pearlman, MD

  • Ophthalmology Physician
  • Libertyville, IL
  • NPI 1528097359

  Multi-Specialty

  NPD (past)
• Agnieszka Robbins

  • Optometrist
  • Arlington Heights, IL
  • NPI 1831571199
  NPD (past)
• Jacqueline Angelina Rola, OD

  • Optometrist
  • Northbrook, IL
  • NPI 1033994322
  NPD (past)
• Azzrah Thobani, OD, FAAO

  • Optometrist
  • Northbrook, IL
  • NPI 1265664502
  NPD (past)
• Erica Taylor Tritsch, OD

  • Optometrist
  • Northbrook, IL
  • NPI 1821668542
  NPD (past)
• Daisy Mendez Weiland, O.D.

  • Optometrist
  • Winnetka, IL
  • NPI 1699181826
  NPD (past)

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1316194285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 GREEN BAY RD",
            "city": "KENILWORTH",
            "state": "IL",
            "postal_code": "600431073",
            "telephone_number": "847-716-2400",
            "fax_number": "847-716-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 GREEN BAY RD",
            "city": "KENILWORTH",
            "state": "IL",
            "postal_code": "600431073",
            "telephone_number": "847-716-2400",
            "fax_number": "847-716-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FENNER PLASTIC SURGERY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-22",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "FENNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "847-716-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "036081864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David S Duda, DDS PC
• Michael S Duda, DDS
• Ekta Duggal, APRN-FNP
• Eye2Eye
• Eyes on the Lake, PC
• Geoffrey C Fenner, MD
• Freund Dental PC
• Gastroenterology Consultants of the North Shore
• Kelly Gingrich, MA
• Susan Glick, MA CCC-SLP

• Plastic Surgery Physician in Kenilworth, IL
• Providers in Kenilworth, IL by specialty
• Plastic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.