Healthcare Provider Details

I. General information

NPI: 1992259337
Provider Name (Legal Business Name): ADVOCATE CONDELL AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2016
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3218
US

IV. Provider business mailing address

825 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3218
US

V. Phone/Fax

Practice location:
  • Phone: 312-489-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE PASENELLI
Title or Position: CEO
Credential:
Phone: 224-504-2215