Healthcare Provider Details

I. General information

NPI: 1598907792
Provider Name (Legal Business Name): AFFILIATED SURGICARE,LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W 63RD ST
CHICAGO IL
60629-5010
US

IV. Provider business mailing address

4200 W 63RD ST
CHICAGO IL
60629-5010
US

V. Phone/Fax

Practice location:
  • Phone: 773-237-0855
  • Fax:
Mailing address:
  • Phone: 773-237-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NASER RUSTOM
Title or Position: PRESIDENT
Credential: M.D
Phone: 773-237-0755