Provider Demographics
NPI:1003953605
Name:NORTHWEST SUBURBAN SURGICAL SPECIALISTS, SC
Entity Type:Organization
Organization Name:NORTHWEST SUBURBAN SURGICAL SPECIALISTS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-255-3314
Mailing Address - Street 1:1430 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4830
Mailing Address - Country:US
Mailing Address - Phone:847-255-3314
Mailing Address - Fax:847-255-3747
Practice Address - Street 1:1430 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4830
Practice Address - Country:US
Practice Address - Phone:847-255-3314
Practice Address - Fax:847-255-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty