St Charles Plastic Surgery, LTD.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

036096824 Issued in IL

Legal business name

ST CHARLES PLASTIC SURGERY, LTD.

Practice address

2900 Foxfield Rd
Suite 201
Saint Charles, IL 60174-5799

Phone

(630) 762-9697

NPI assigned

Sep 19, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Bahram Ghaderi, MD, FACS

Title

President

Phone

(630) 762-9697

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369785600000",
    "number": "1427244987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD",
            "address_2": "SUITE 201",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-762-9697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD",
            "address_2": "SUITE 201",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-762-9697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CHARLES PLASTIC SURGERY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-19",
        "last_updated": "2013-05-29",
        "status": "A",
        "authorized_official_last_name": "GHADERI",
        "authorized_official_first_name": "BAHRAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-762-9697",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, FACS"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "036096824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Saint Charles, IL
• Providers in Saint Charles, 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 May 29, 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.