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NPI Code Detail

MEDICARE: AFFILIATED SURGICARE,LTD.

MEDICARE: AFFILIATED SURGICARE,LTD.
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1598907792
Entity Type Code : Organization
Provider Name (Legal Business Name) : AFFILIATED SURGICARE,LTD.
Provider Business Mailing Address
First Line : 4200 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-5010
Country : US
Telephone Number : 773-237-0855
Fax Number :
Provider Business Practice Location Address
First Line : 4200 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-5010
Country : US
Telephone Number : 773-237-0855
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. NASER RUSTOM
Credential : M.D
Telephone Number : 773-237-0755
Provider Enumeration Date : 04/02/2009
Last Update Date : 04/02/2009

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Directions to “AFFILIATED SURGICARE,LTD. ” Practice Location

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