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General NPI Number Information
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NPI Number | 1699008706
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Entity Type | Organization
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Legal Business Name | S. O. GROUP, S.C.
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 1725 W. HARRISON STREET SUITE 409
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-942-2302
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Fax | 312-563-2228
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Provider Business Mailing Address
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Address Line | 1725 W. HARRISON STREET SUITE 409
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-942-2302
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Fax | 312-563-2228
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS R. WITT
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Credential | MD
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Telephone | 312-942-2302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 042.006019
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 042.006019
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License Number State | IL
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