=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417036021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUBURBAN SURGICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 W FRONTAGE RD SECOND FLOOR
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60093-3467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-550-0040
-----------------------------------------------------
Fax | 847-550-0022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 W. ROUTE 22
-----------------------------------------------------
City | LAKE ZURICH
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60047-3416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-550-0040
-----------------------------------------------------
Fax | 847-784-0045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER & CEO
-----------------------------------------------------
Name | MR. SALVADOR YUNEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 847-550-0040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | D61444866
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------