| Facial Plastic & Laser Surgery Center, Llc | |
|
7301 N Knoxville Ave Peoria IL 61614-2017 | |
| (309) 589-3233 | |
| (309) 689-0312 |
| Full Name | Facial Plastic & Laser Surgery Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7301 N Knoxville Ave, Peoria, Illinois |
| Authorized Official Name and Position | Robert J Tudor (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3095898053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Facial Plastic & Laser Surgery Center, Llc 7301 N Knoxville Ave Peoria IL 61614-2017 Ph: (309) 589-3233 | Facial Plastic & Laser Surgery Center, Llc 7301 N Knoxville Ave Peoria IL 61614-2017 Ph: (309) 589-3233 |
| NPI Number | 1194888677 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1557455961 |
|---|---|
| Medicare Enrollment ID | O20070917000132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194888677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Illinois) | Primary |
| Provider Name | Harrison C Putman |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1477524171 PECOS PAC ID: 6204876857 Enrollment ID: I20070917000184 |
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