MEDICARE: AMERICAN SURGEONS GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK4095	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01632534	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1376567958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN SURGEONS GROUP INC

Provider Business Mailing Address
First Line	:	1757 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1812
Country	:	US
Telephone Number	:	708-799-7500
Fax Number	:	815-215-1144

Provider Business Practice Location Address
First Line	:	1757 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1812
Country	:	US
Telephone Number	:	708-799-7500
Fax Number	:	708-798-4563

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIA EVE SHAUGER
Credential	:	DPM
Telephone Number	:	708-799-7500

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	06/29/2015

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Directions to “AMERICAN SURGEONS GROUP INC ” Practice Location

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