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General NPI Number Information
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NPI Number | 1760781488
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Entity Type | Organization
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Legal Business Name | SR SURGICAL ASSIST INC
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 37W716 STRATFORD LN
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City | ELGIN
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State | IL
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Zip | 60124-6750
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Country | US
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Telephone | 630-837-9461
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Fax | 630-837-7640
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Provider Business Mailing Address
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Address Line | 37W716 STRATFORD LN
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City | ELGIN
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State | IL
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Zip | 60124-6750
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Country | US
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Telephone | 630-837-9461
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Fax | 630-837-7640
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD PAWLOWSKI
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Credential | D.O.
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Telephone | 630-837-9461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036-066757
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License Number State | IL
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