MEDICARE: CDN SURGICAL ASSOC., LTD.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	2086X0206X	Surgical Oncology Physician	IL
2	208C00000X	Colon & Rectal Surgery Physician	IL
3	2086S0129X	Vascular Surgery Physician	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA6608	OTHER	IL	MEDICARE RAILROAD PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0001618161	OTHER	IL	BC BS OF IL GROUP NUMBER

General Provider Information

NPI Number	:	1528114501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDN SURGICAL ASSOC., LTD.

Provider Business Mailing Address
First Line	:	PO BOX 597995
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60695-0001
Country	:	US
Telephone Number	:	773-472-3427
Fax Number	:	773-472-8561

Provider Business Practice Location Address
First Line	:	2913 N COMMONWEALTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6211
Country	:	US
Telephone Number	:	773-472-3427
Fax Number	:	773-472-8561

Authorized Official
Title or Position	:	MEDICAL BILLING MANAGER
Name	:	MRS. KAREN URSO
Credential	:
Telephone Number	:	773-763-3445

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	12/21/2007

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Directions to “CDN SURGICAL ASSOC., LTD. ” Practice Location

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