Healthcare Provider Details

I. General information

NPI: 1851170575
Provider Name (Legal Business Name): N.T. SURGICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 N CAMPBELL AVE APT G
CHICAGO IL
60647-6718
US

IV. Provider business mailing address

1713 N CAMPBELL AVE APT G
CHICAGO IL
60647-6718
US

V. Phone/Fax

Practice location:
  • Phone: 309-530-3407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RYLAN MIYAT
Title or Position: CERTIFIED SURGICAL FIRST ASSISTANT
Credential:
Phone: 309-530-3407