Center for Cosmetic and Laser Surgery, LLC

NPI #1215276530 in Bloomington, Illinois

Provider Information

NPI Number: 1215276530
Entity Type: Organization
Organization Name: Center for Cosmetic and Laser Surgery, LLC
Primary Specialty: Plastic Surgery
Enumeration Date: Feb 6, 2013
Last Updated: Feb 6, 2013

Practice Location

Address: 1505 EASTLAND DR
Address 2: STE 350
City: Bloomington
State: Illinois
ZIP Code: 61701-3534
Phone: (309) 663-1222

Authorized Official

Name: DR. JEFFREY S POULTER, MD
Title: OWNER
Phone: (309) 663-1222

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Plastic Surgery	208200000X	Primary

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