Healthcare Provider Details

I. General information

NPI: 1023103769
Provider Name (Legal Business Name): OAK LAWN ENDOSCOPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 SOUTHWEST HIGHWAY
OAK LAWN IL
60453
US

IV. Provider business mailing address

9921 SOUTHWEST HIGHWAY
OAK LAWN IL
60453
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-2552
  • Fax:
Mailing address:
  • Phone: 708-425-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7002603
License Number StateIL

VIII. Authorized Official

Name: THOMAS ARNDT
Title or Position: CHIEF FINANCIAL OFFICER
Credential: MD
Phone: 708-425-9456