Healthcare Provider Details

I. General information

NPI: 1306663893
Provider Name (Legal Business Name): CHICAGOLAND SURGERY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17W682 BUTTERFIELD RD
OAKBROOK TERRACE IL
60181-4029
US

IV. Provider business mailing address

17W682 BUTTERFIELD RD
OAKBROOK TERRACE IL
60181-4029
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-9393
  • Fax: 708-636-2022
Mailing address:
  • Phone: 708-636-9393
  • Fax: 708-636-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MOHAMMAD AL-KHUDARI
Title or Position: MD
Credential: MD
Phone: 815-557-3555