Healthcare Provider Details

I. General information

NPI: 1992770903
Provider Name (Legal Business Name): WEST SUBURBAN NEUROSURGICAL ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E OGDEN AVE STE 106
WESTMONT IL
60559-1283
US

IV. Provider business mailing address

PO BOX 433
WESTMONT IL
60559-0433
US

V. Phone/Fax

Practice location:
  • Phone: 630-655-1229
  • Fax: 630-655-0185
Mailing address:
  • Phone: 630-655-1229
  • Fax: 630-655-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD 4922-407-9
License Number StateIL

VIII. Authorized Official

Name: MISS CAULDEEN M CALMEYN
Title or Position: ADMINISTRATOR
Credential:
Phone: 630-655-1229