Healthcare Provider Details

I. General information

NPI: 1174501266
Provider Name (Legal Business Name): ASSOCIATED GENERAL SURGEONS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 410
WINFIELD IL
60190-1237
US

IV. Provider business mailing address

25 N WINFIELD RD STE 410
WINFIELD IL
60190-1237
US

V. Phone/Fax

Practice location:
  • Phone: 630-665-2101
  • Fax: 630-665-3820
Mailing address:
  • Phone: 630-665-2101
  • Fax: 630-665-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY ANN CARNEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 630-665-2101