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General NPI Number Information
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NPI Number | 1790954725
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Entity Type | Organization
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Legal Business Name | THE AMBROSE GROUP, INC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 328 W SAUK TRL
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City | FRANKFORT
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State | IL
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Zip | 60423-7778
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Country | US
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Telephone | 708-721-1463
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Fax | 708-234-7133
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Provider Business Mailing Address
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Address Line | 328 W SAUK TRL
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City | FRANKFORT
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State | IL
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Zip | 60423-7778
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Country | US
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Telephone | 708-721-1463
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Fax | 708-234-7133
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Authorized Official
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Title or Position | PHYSICIAN ASST. / SURGEON ASST.
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Name | MARK AMBROSE
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Credential | PA
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Telephone | 708-721-1463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | IL
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