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General NPI Number Information
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NPI Number | 1851394696
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Entity Type | Organization
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Legal Business Name | AFFILIATED SURGEONS OF ROCKFORD LLC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 2300 N ROCKTON AVE STE 304
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City | ROCKFORD
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State | IL
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Zip | 61103-3619
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Country | US
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Telephone | 815-964-3333
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Fax | 815-964-3134
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Provider Business Mailing Address
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Address Line | PO BOX 15730
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City | LOVES PARK
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State | IL
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Zip | 61132-5730
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Country | US
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Telephone | 815-964-3333
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Fax | 815-964-3134
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Authorized Official
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Title or Position | CONTROLLING PARTNER
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Name | DR. PAUL J KLAZURA
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Credential | M.D.
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Telephone | 815-489-6034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 036104533
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036063647
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 036064410
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036048085
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036101179
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 036067268
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036064323
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085002211
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License Number State | IL
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Taxonomy #9
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209004303
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License Number State | IL
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Taxonomy #10
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 036071666
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License Number State | IL
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Taxonomy #11
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036062833
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License Number State | IL
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