MEDICARE: SIX CORNERS SURGERY PARTNERS, LLC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1811854276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIX CORNERS SURGERY PARTNERS, LLC

Provider Business Mailing Address
First Line	:	4211 N CICERO AVE STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1649
Country	:	US
Telephone Number	:	617-905-6922
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 N CICERO AVE STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1649
Country	:	US
Telephone Number	:	617-905-6922
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JOSEPH MARTIN THOMAS BOOKER
Credential	:
Telephone Number	:	617-905-6922

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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