Provider Demographics
NPI:1225100654
Name:W.A.SURGICAL ASSOSC. S.C.
Entity Type:Organization
Organization Name:W.A.SURGICAL ASSOSC. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VASCULAR SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MULJI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUWAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-957-9105
Mailing Address - Street 1:17850 KEDZIE AVE STE LL05
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2060
Mailing Address - Country:US
Mailing Address - Phone:708-957-9105
Mailing Address - Fax:708-647-3284
Practice Address - Street 1:17850 KEDZIE AVE STE LL05
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2060
Practice Address - Country:US
Practice Address - Phone:708-957-9105
Practice Address - Fax:708-647-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILB7991Medicare UPIN