Healthcare Provider Details

I. General information

NPI: 1811944515
Provider Name (Legal Business Name): UNITED SHOCKWAVE SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W DEMPSTER ST SUITE G04
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

PO BOX 95439
GRAPEVINE TX
76099-9735
US

V. Phone/Fax

Practice location:
  • Phone: 847-544-5853
  • Fax:
Mailing address:
  • Phone: 877-465-4845
  • Fax: 847-297-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY NORRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 847-544-5853