Healthcare Provider Details

I. General information

NPI: 1437283207
Provider Name (Legal Business Name): DPNS SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SKOKIE BLVD 450
NORTHBROOK IL
60062-7930
US

IV. Provider business mailing address

400 SKOKIE BLVD 450
NORTHBROOK IL
60062-7930
US

V. Phone/Fax

Practice location:
  • Phone: 847-272-4433
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number36109475
License Number StateIL

VIII. Authorized Official

Name: JAMES G LAHTI
Title or Position: PHYSICIAN
Credential:
Phone: 847-272-4433