Provider Demographics
NPI:1033254834
Name:W.A.SURGICAL ASSOSCIATES.S.C
Entity Type:Organization
Organization Name:W.A.SURGICAL ASSOSCIATES.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MULJI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUWAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACS
Authorized Official - Phone:708-481-6994
Mailing Address - Street 1:54 GRAYMOOR LN
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1218
Mailing Address - Country:US
Mailing Address - Phone:708-481-6994
Mailing Address - Fax:708-748-4069
Practice Address - Street 1:54 GRAYMOOR LN
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1218
Practice Address - Country:US
Practice Address - Phone:708-481-6994
Practice Address - Fax:708-748-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360618232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061823Medicaid
IL606250Medicare ID - Type UnspecifiedPROVIDER NUMBER