Healthcare Provider Details

I. General information

NPI: 1215170246
Provider Name (Legal Business Name): ILLINOIS SURGICAL SPECIALISTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 N KNOXVILLE AVE
PEORIA IL
61614-2079
US

IV. Provider business mailing address

7725 N KNOXVILLE AVE
PEORIA IL
61614-2079
US

V. Phone/Fax

Practice location:
  • Phone: 309-495-0240
  • Fax: 309-689-9035
Mailing address:
  • Phone: 309-495-0240
  • Fax: 309-689-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDY C CHIOU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 309-495-0240