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General NPI Number Information
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NPI Number | 1306081625
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Entity Type | Organization
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Legal Business Name | UNIVERSITY THORACIC SURGEONS
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST SUITE 774
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City | CHICAGO
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State | IL
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Zip | 60612-3841
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Country | US
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Telephone | 312-738-3732
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Fax | 312-738-9763
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Provider Business Mailing Address
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Address Line | 1725 W HARRISON ST SUITE 774
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City | CHICAGO
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State | IL
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Zip | 60612-3841
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Country | US
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Telephone | 312-738-3732
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Fax | 312-738-9763
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MS. SALLY Y SA
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Credential | PA-C
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Telephone | 312-738-3732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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