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General NPI Number Information
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NPI Number | 1770529612
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Entity Type | Organization
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Legal Business Name | GENERAL SURGEONS OF KANKAKEE LTD
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 375 N WALL ST SUITE P640
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City | KANKAKEE
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State | IL
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Zip | 60901-3483
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Country | US
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Telephone | 815-932-0911
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Fax | 815-932-0631
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Provider Business Mailing Address
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Address Line | 777 OAKMONT LN SUITE 1600
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City | WESTMONT
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State | IL
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Zip | 60559-5511
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Country | US
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Telephone | 630-789-2550
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL ROWLAND
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Credential | MD
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Telephone | 815-932-0911
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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 |
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License Number State |
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