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General NPI Number Information
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NPI Number | 1053597161
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Entity Type | Organization
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Legal Business Name | 1800 MCDONOUGH ROAD SURGERY CENTER LLC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 1800 MCDONOUGH RD SUITE 100
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-4566
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Country | US
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Telephone | 847-742-7272
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 W 22ND ST SUITE 48
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City | OAK BROOK
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State | IL
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Zip | 60523-1231
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Country | US
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Telephone | 630-990-7770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIANOOSH JAFARI
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Credential | M.D.
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Telephone | 630-990-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7003116
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License Number State | IL
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