Organization Name: | SURGICAL CENTER OF OAKBROOK TERRACE |
NPI Number: | 1154560308 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPH M COSCINO (PRESIDENT) |
Mailing Address: | 1s067 Summit Ave Oakbrook Terrace |
State: | IL US |
Postal Code: | 601813978 |
Phone Number: | 6302619500 |
Fax Number: | 6302619504 |
NPI Enumeration Date: | 02/11/2009 |
NPI Last Update Date: | 02/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP1100X |
License Number: | 016004563 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Podiatric |
Taxonomy Definition: |