1356293906 NPI number — CENTER OF EXCELLENCE IN PLASTIC, AESTHETIC, AND RECONSTRUCTIVE SURGERY, INC.

Table of content: (NPI 1356293906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356293906 NPI number — CENTER OF EXCELLENCE IN PLASTIC, AESTHETIC, AND RECONSTRUCTIVE SURGERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER OF EXCELLENCE IN PLASTIC, AESTHETIC, AND RECONSTRUCTIVE SURGERY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356293906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
152 W HURON ST UNIT 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60654-7384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-371-4248
Provider Business Mailing Address Fax Number:
312-284-1030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 E SAMUEL AVE APT 3D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61616-6497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-371-4248
Provider Business Practice Location Address Fax Number:
312-284-1030
Provider Enumeration Date:
02/13/2026

Additional Information

Authorized Official

Authorized Official Last Name:
DORAFSHAR
Authorized Official First Name:
AMIR
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-371-4248

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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