Healthcare Provider Details

I. General information

NPI: 1548579576
Provider Name (Legal Business Name): WEST SUBURBAN SURGICAL, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N HIGHLAND AVE SUITE 203
AURORA IL
60506-1400
US

IV. Provider business mailing address

1315 N HIGHLAND AVE SUITE 203
AURORA IL
60506-1400
US

V. Phone/Fax

Practice location:
  • Phone: 630-897-1282
  • Fax: 630-906-9860
Mailing address:
  • Phone: 630-897-1282
  • Fax: 630-906-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIK BORNCAMP
Title or Position: DOCTOR
Credential: M.D.
Phone: 630-897-1282