Basic Information
| Provider Information | |||||||||
| NPI: | 1235109745 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGEONS GROUP, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N WESTMORELAND RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472344310 | ||||||||
| FaxNumber: | 8472344336 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N WESTMORELAND RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472344310 | ||||||||
| FaxNumber: | 8472344336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 08/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOUSTON | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | DALE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8472344310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 042-000369 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | 042-000369 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.