Advanced Facial Plastics & Mohs
Dermatology, MOHS-Micrographic Surgery in Rockford, IL. Organization (NPI-2).
NPI number1922295328
StatusActive
Last updated in NPPESNov 8, 2007
Details
- NPI
- 1922295328
- Entity type
- Organization (NPI-2)
- Legal business name
- Advanced Facial Plastics & Mohs
- Organization subpart
- No
- Enumeration date
- Sep 28, 2007
- Last updated
- Nov 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207ND0101X | Dermatology, MOHS-Micrographic Surgery | 036104814 | IL | Yes |
| 208200000X | Plastic Surgery | 036104814 | IL | |
| 2082S0099X | Plastic Surgery, Plastic Surgery Within the Head and Neck | 036104814 | IL |
Practice location
1235 N Mulford RdSuite 100
Rockford, IL 61107-3879
Phone 815-484-9900
Mailing address
1235 N Mulford RdSuite 100
Rockford, IL 61107-3879
Phone 815-484-9900
Authorized official
Kimberly Macmurchy
Contracting And Credentialing
8154849900
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