MEDICARE: SURGICAL SPECIALTIES, LTD.

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	174400000X	Specialist	186	MN

General Provider Information

NPI Number	:	1942265434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SPECIALTIES, LTD.

Provider Business Mailing Address
First Line	:	470 W 78TH ST
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-4539
Country	:	US
Telephone Number	:	952-224-9350
Fax Number	:	952-224-9356

Provider Business Practice Location Address
First Line	:	470 W 78TH ST
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-4524
Country	:	US
Telephone Number	:	952-224-9350
Fax Number	:	952-224-9356

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JILL M. JULSRUD
Credential	:	M.D.
Telephone Number	:	952-224-9350

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	10/18/2012

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