Healthcare Provider Details

I. General information

NPI: 1225284490
Provider Name (Legal Business Name): ARENAS SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 IONE LN
AURORA IL
60503-7826
US

IV. Provider business mailing address

1999 IONE LN
AURORA IL
60503-7826
US

V. Phone/Fax

Practice location:
  • Phone: 847-208-6982
  • Fax: 630-340-3102
Mailing address:
  • Phone: 847-208-6982
  • Fax: 630-340-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number23800181
License Number StateIL

VIII. Authorized Official

Name: ARIS JOHN B. ARENAS
Title or Position: OWNER
Credential: R.S.A
Phone: 847-208-6982