Basic Information
| Provider Information | |||||||||
| NPI: | 1154560308 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL CENTER OF OAKBROOK TERRACE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1S067 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302619500 | ||||||||
| FaxNumber: | 6302619504 | ||||||||
| Practice Location | |||||||||
| Address1: | 1S067 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302619500 | ||||||||
| FaxNumber: | 6302619504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | COSCINO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6302619500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP1100X | 016004563 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Podiatric |
No ID Information.