Healthcare Provider Details

I. General information

NPI: 1528114501
Provider Name (Legal Business Name): CDN SURGICAL ASSOC., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 N COMMONWEALTH AVE
CHICAGO IL
60657-6211
US

IV. Provider business mailing address

PO BOX 597995
CHICAGO IL
60695-0001
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-3427
  • Fax: 773-472-8561
Mailing address:
  • Phone: 773-472-3427
  • Fax: 773-472-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. KAREN URSO
Title or Position: MEDICAL BILLING MANAGER
Credential:
Phone: 773-763-3445