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General NPI Number Information
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NPI Number | 1821544750
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Entity Type | Organization
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Legal Business Name | AFFORDABLE OFFICE BASED SURGERY
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 5600 N SHERIDAN RD SUITE 104
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City | CHICAGO
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State | IL
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Zip | 60660-4877
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Country | US
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Telephone | 773-944-0365
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 N SHERIDAN RD SUITE 104
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City | CHICAGO
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State | IL
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Zip | 60660
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Country | US
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Telephone | 773-944-0365
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW ENGEL
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Credential | MD
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Telephone | 773-944-0365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 036120188
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License Number State | IL
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