Healthcare Provider Details

I. General information

NPI: 1861589020
Provider Name (Legal Business Name): NORTHERN ILLINOIS EMERGENCY SURGICAL SERV LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

PO BOX 56341
CHICAGO IL
60656-0341
US

V. Phone/Fax

Practice location:
  • Phone: 708-867-4949
  • Fax: 708-867-4981
Mailing address:
  • Phone: 708-867-4949
  • Fax: 708-867-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ANTHONY E RASPANTI
Title or Position: DIRECTOR
Credential: MD
Phone: 708-867-4949