Healthcare Provider Details

I. General information

NPI: 1235440835
Provider Name (Legal Business Name): NW SURGICAL CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 W HIGGINS RD
HOFFMAN ESTATES IL
60169
US

IV. Provider business mailing address

1260 W HIGGINS RD
HOFFMAN ESTATES IL
60169
US

V. Phone/Fax

Practice location:
  • Phone: 847-839-1111
  • Fax: 847-839-1123
Mailing address:
  • Phone: 847-839-1111
  • Fax: 847-839-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number042619629
License Number StateIL

VIII. Authorized Official

Name: MR. MAHMOUD M TAYEB
Title or Position: OFFICE CONSULTANT
Credential:
Phone: 847-387-9365