Gold Coast Plastic Surgery LLC

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

License

036104040 Issued in IL

Legal business name

GOLD COAST PLASTIC SURGERY LLC

Practice address

1 E Erie St
Suite 640
Chicago, IL 60611-2740

Phone

(312) 988-9300

Fax

(312) 988-9310

NPI assigned

Mar 6, 2008

Organization subpart

No

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

Authorized official

Name

Mary G. Forde

Title

Office Manager

Phone

(312) 988-9300

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231200000000",
    "number": "1821268772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 E ERIE ST",
            "address_2": "SUITE 640",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112740",
            "telephone_number": "312-988-9300",
            "fax_number": "312-988-9310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E ERIE ST",
            "address_2": "SUITE 640",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112740",
            "telephone_number": "312-988-9300",
            "fax_number": "312-988-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLD COAST PLASTIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2009-01-06",
        "status": "A",
        "authorized_official_last_name": "FORDE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "312-988-9300"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "IL",
            "license": "036104040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548342355",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "H92062",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gold Coast Internal Medicine
• Gold Coast Orthopaedic and Spine Surgery S C
• Gold Coast Orthopaedic and Spine Surgery SC
• Gold Coast Osteopathic, PSC
• Gold Coast Osteopathic, PSC
• Gold Coast Podiatry Center, LLC
• Gold Coast Podiatry Center, LLC
• Gold Coast Podiatry Center, LLC
• Gold Coast Podiatry Center, LLC
• Gold Coast Surgicenter, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.