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General NPI Number Information
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NPI Number | 1336255124
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Entity Type | Organization
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Legal Business Name | ASSOCIATED SURGICAL GROUP, SC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 7303 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-2017
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Country | US
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Telephone | 309-691-4005
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Fax | 309-691-6144
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Provider Business Mailing Address
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Address Line | 7303 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-2017
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Country | US
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Telephone | 309-691-4005
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Fax | 309-691-6144
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GAVISH N PATEL
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Credential | M.D.
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Telephone | 309-691-4005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 042-000313
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License Number State | IL
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