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General NPI Number Information
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NPI Number | 1881757250
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Entity Type | Organization
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Legal Business Name | SUMMITSURG PROCEDURE CENTER
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 431 SUMMIT ST
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City | ELGIN
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State | IL
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Zip | 60120-3861
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Country | US
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Telephone | 847-289-5555
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Fax | 847-289-5577
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Provider Business Mailing Address
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Address Line | 431 SUMMIT ST
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City | ELGIN
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State | IL
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Zip | 60120-3861
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Country | US
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Telephone | 847-289-5555
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Fax | 847-289-5577
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN V PRUNSKIS
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Credential | M.D.
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Telephone | 847-289-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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