1629279518 NPI number — MIDWEST COSMETIC INSTITUTE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629279518 NPI number — MIDWEST COSMETIC INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST COSMETIC INSTITUTE
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:
1629279518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 ACADEMY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-223-9494
Provider Business Mailing Address Fax Number:
847-205-9722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 MCHENRY RD
Provider Second Line Business Practice Location Address:
SUITE 130A
Provider Business Practice Location Address City Name:
BUFFALO GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60089-1370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-223-9494
Provider Business Practice Location Address Fax Number:
847-205-9722
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZAYAN
Authorized Official First Name:
MAYER
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
847-223-9494

Provider Taxonomy Codes

  • Taxonomy code: 163WS0121X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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