Provider Demographics
NPI:1093753550
Name:ENT SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ENT SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JESUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-744-2500
Mailing Address - Street 1:3077 W JEFFERSON ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5262
Mailing Address - Country:US
Mailing Address - Phone:815-744-2500
Mailing Address - Fax:815-744-3550
Practice Address - Street 1:3077 W JEFFERSON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-744-2500
Practice Address - Fax:815-744-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty