Healthcare Provider Details

I. General information

NPI: 1851547491
Provider Name (Legal Business Name): ENT SURGERY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST SUITE 401
CHICAGO IL
60657-5188
US

IV. Provider business mailing address

5005 TOUHY AVE SUITE 200
SKOKIE IL
60077-3548
US

V. Phone/Fax

Practice location:
  • Phone: 312-236-3642
  • Fax: 312-236-5162
Mailing address:
  • Phone: 312-236-3642
  • Fax: 312-236-5162

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: MICHAEL FRIEDMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-236-3642