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General NPI Number Information
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NPI Number | 1962070896
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Entity Type | Organization
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Legal Business Name | OAK ASC, LLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 6712 N CONVENT ST
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1528
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Country | US
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Telephone | 815-928-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 400 S KENNEDY DR
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City | BRADLEY
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State | IL
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Zip | 60915-2682
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Country | US
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Telephone | 815-928-8050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL CORCORAN
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Credential | MD
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Telephone | 815-928-8050
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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 |
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License Number State |
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