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General NPI Number Information
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NPI Number | 1225528979
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Entity Type | Organization
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Legal Business Name | THORACIC SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 10604 SOUTHWEST HIGHWAY SUITE 101
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415
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Country | US
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Telephone | 708-346-4065
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Fax | 708-423-5799
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Provider Business Mailing Address
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Address Line | 10604 SOUTHWEST HIGHWAY SUITE 101
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415
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Country | US
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Telephone | 708-346-4065
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Fax | 708-423-5799
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL GORDON
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Credential | MD
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Telephone | 708-346-4065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | PENDING
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License Number State | IL
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