Healthcare Provider Details

I. General information

NPI: 1558484022
Provider Name (Legal Business Name): SURGICAL HEALTH ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE STE 210
AURORA IL
60504-5895
US

IV. Provider business mailing address

2020 OGDEN AVE STE 210
AURORA IL
60504-5895
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-0200
  • Fax: 630-585-7396
Mailing address:
  • Phone: 630-585-0200
  • Fax: 630-585-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLEN D BLOOM
Title or Position: OWNER
Credential: MD
Phone: 630-585-0200