Healthcare Provider Details

I. General information

NPI: 1164718706
Provider Name (Legal Business Name): PEAK SURGICAL ASSISTANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 ROYAL GLEN DR APT 315
GLEN ELLYN IL
60137-6032
US

IV. Provider business mailing address

PO BOX 309
MONEE IL
60449-0309
US

V. Phone/Fax

Practice location:
  • Phone: 630-205-5206
  • Fax: 630-205-5206
Mailing address:
  • Phone: 630-205-5206
  • Fax: 630-205-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARIA KLARITIS
Title or Position: PRESIDENT
Credential: CSA
Phone: 847-392-8800