Healthcare Provider Details

I. General information

NPI: 1831104652
Provider Name (Legal Business Name): NORTHWEST ADVANCED SURGICAL ASSOCIATES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6374 N LINCOLN AVE SUITE 301
CHICAGO IL
60659-1275
US

IV. Provider business mailing address

6374 N LINCOLN AVE SUITE 301
CHICAGO IL
60659-1275
US

V. Phone/Fax

Practice location:
  • Phone: 773-478-5600
  • Fax: 773-478-5602
Mailing address:
  • Phone: 773-478-5600
  • Fax: 773-478-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SPIROS GIANNOULIAS
Title or Position: DIRECTOR
Credential: MD
Phone: 773-478-5600