Dewolfe Aesthetic Services SC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

DEWOLFE AESTHETIC SERVICES SC

Practice address

3357 N. Southport Aveune
Chicago, IL 60657

Phone

(434) 284-8770

Fax

(914) 206-4144

NPI assigned

May 11, 2020

Organization subpart

No

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

Authorized official

Name

Judith Polhemus

Title

Billing Manager

Phone

(434) 284-8770

Specialties & licenses 1

Addresses

Other names 1

• DeWolfe Aesthetic Services SC Former legal business name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Sean Dewolfe, M.D.

  • Plastic Surgery Physician
  • Berwyn, IL
  • NPI 1538307566
  Medicare reassignment NPD

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1467074617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3357 N. SOUTHPORT AVEUNE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "434-284-8770",
            "fax_number": "914-206-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3357 N. SOUTHPORT AVEUNE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "434-284-8770",
            "fax_number": "914-206-4144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEWOLFE AESTHETIC SERVICES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "POLHEMUS",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "434-284-8770"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeWolfe Aesthetic Services SC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• April Dewhite, M.D.
• Morgan Paige Dewilde
• Madison Ann Dewinter
• Kelly Dewitt, D.T
• Lauren A Dewitt
• Kally Ann Dey, DO
• Rahul Dey
• Shirin Ann Dey, MD
• Dezanek Podiatry Center LTD
• Robert Charles Dezanek, DPM

• 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 May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.