Healthcare Provider Details

I. General information

NPI: 1922207968
Provider Name (Legal Business Name): SURGICAL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N HAMMES AVE
JOLIET IL
60435-8117
US

IV. Provider business mailing address

10660 W 143RD ST STE B
ORLAND PARK IL
60462-1989
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-0005
  • Fax:
Mailing address:
  • Phone: 708-349-0055
  • Fax: 708-460-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number36085080
License Number StateIL

VIII. Authorized Official

Name: SAEED DARBANDI SR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-349-0055