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General NPI Number Information
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NPI Number | 1902949613
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Entity Type | Organization
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Legal Business Name | ELMWOOD PARK SAME DAY SURGERY LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 1614 N HARLEM AVE
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City | ELMWOOD PARK
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State | IL
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Zip | 60707-4302
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Country | US
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Telephone | 708-452-5000
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Fax | 708-452-5588
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Provider Business Mailing Address
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Address Line | 1614 N HARLEM AVE
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City | ELMWOOD PARK
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State | IL
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Zip | 60707-4302
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Country | US
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Telephone | 708-452-5000
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Fax | 708-452-5588
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIM ZIDONIS
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Credential |
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Telephone | 312-573-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7002387
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License Number State | IL
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