| Organization Name: | FENNER PLASTIC SURGERY, LTD |
| NPI Number: | 1134591191 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAE SWITZER (BILLING MANAGER) |
| Mailing Address: | 512 Green Bay Rd Kenilworth |
| State: | IL US |
| Postal Code: | 600431073 |
| Phone Number: | 8477162416 |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2015 |
| NPI Last Update Date: | 10/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |