Basic Information
| Provider Information | |||||||||
| NPI: | 1053597161 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 1800 MCDONOUGH ROAD SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2607 W 22ND ST | ||||||||
| Address2: | SUITE 48 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309907770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 MCDONOUGH RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOFFMAN ESTATES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601924566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477427272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2008 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | JAFARI | ||||||||
| AuthorizedOfficialFirstName: | KIANOOSH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6309907770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 7003116 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.