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General NPI Number Information
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NPI Number | 1487115804
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Entity Type | Organization
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Legal Business Name | ONTARIO STREET OPERATORY FAC
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 22 W ONTARIO STREET OPERATORY
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-642-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 22 W ONTARIO STREET OPERATORY
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-642-0400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY WEINZWEIG
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Credential | MD
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Telephone | 312-642-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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