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General NPI Number Information
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NPI Number | 1780830307
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Entity Type | Organization
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Legal Business Name | MIDWEST SURGICAL FACILITY
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 1851 DOUGLAS RD
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City | MONTGOMERY
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State | IL
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Zip | 60538-2159
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Country | US
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Telephone | 630-892-0000
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Fax | 630-892-0000
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Provider Business Mailing Address
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Address Line | 1851 DOUGLAS RD
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City | MONTGOMERY
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State | IL
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Zip | 60538-2159
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Country | US
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Telephone | 630-892-0000
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Fax | 630-892-0000
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRAVEEN K VOHRA
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Credential | DPM
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Telephone | 630-892-0000
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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 | 016004798
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License Number State | IL
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