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NPI Code Detail

MEDICARE: LAPAROSCOPY INTERNATIONAL LLC

MEDICARE: LAPAROSCOPY INTERNATIONAL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician036050637IL
2208600000XSurgery Physician036050637IL
3174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12232804OTHERILBC/BS PIN NUMBER

General Provider Information

NPI Number : 1093850331
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAPAROSCOPY INTERNATIONAL LLC
Provider Business Mailing Address
First Line : 4333 MAIN ST
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-2869
Country : US
Telephone Number : 630-810-0212
Fax Number : 630-810-1027
Provider Business Practice Location Address
First Line : 3714 W 26TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-3824
Country : US
Telephone Number : 630-810-0212
Fax Number : 630-810-1027
Authorized Official
Title or Position : BILLING MANAGER
Name : MRS. KRISTINA L BUTLER
Credential :
Telephone Number : 630-810-1219
Provider Enumeration Date : 02/21/2007
Last Update Date : 12/09/2010

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