MEDICARE: SURGICAL CENTER OF OAKBROOK TERRACE

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
1	261QP1100X	Podiatric Clinic/Center	016004563	IL

General Provider Information

NPI Number	:	1154560308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL CENTER OF OAKBROOK TERRACE

Provider Business Mailing Address
First Line	:	1S067 SUMMIT AVE
Second Line	:
City	:	OAKBROOK TERRACE
State	:	IL
Zip	:	60181-3978
Country	:	US
Telephone Number	:	630-261-9500
Fax Number	:	630-261-9504

Provider Business Practice Location Address
First Line	:	1S067 SUMMIT AVE
Second Line	:
City	:	OAKBROOK TERRACE
State	:	IL
Zip	:	60181-3978
Country	:	US
Telephone Number	:	630-261-9500
Fax Number	:	630-261-9504

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH M COSCINO
Credential	:	DPM
Telephone Number	:	630-261-9500

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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Practice Location Address:

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