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General NPI Number Information
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NPI Number | 1245744515
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Entity Type | Organization
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Legal Business Name | CHIEF SURGICAL ASSISTANTS
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Dates
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Enumeration Date | 11/25/2017
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 1248 BERRY LN
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City | FLOSSMOOR
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State | IL
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Zip | 60422
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Country | US
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Telephone | 708-215-1604
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Fax |
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Provider Business Mailing Address
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Address Line | 1248 BERRY LN
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City | FLOSSMOOR
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State | IL
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Zip | 60422-1410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT
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Name | MR. KESHAWN GARDNER
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Credential | CSFA
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Telephone | 708-215-1604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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