Healthcare Provider Details

I. General information

NPI: 1265665301
Provider Name (Legal Business Name): SPECIALTY HEALTHCARE SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W DIVERSEY PKWY SUITE 200
CHICAGO IL
60614-1454
US

IV. Provider business mailing address

PO BOX 636
PARK RIDGE IL
60068-0636
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-6040
  • Fax: 773-880-6107
Mailing address:
  • Phone: 773-880-6040
  • Fax: 773-880-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: JAMES A. UNTI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-880-6040