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General NPI Number Information
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NPI Number | 1861770182
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Entity Type | Organization
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Legal Business Name | SURGICAL PARTNERS
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 4440 W 95TH ST ADVOCATE MEDICAL GROUP - SURGICAL PARTNERS
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City | OAK LAWN
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State | IL
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Zip | 60453-2600
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Country | US
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Telephone | 312-731-4949
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 437 SURGICAL PARTNERS
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-0437
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Country | US
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Telephone | 312-731-4949
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. YASER A MAKSOUD
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Credential | M.D.
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Telephone | 312-731-4949
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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 | 238.000220
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License Number State | IL
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