Provider Demographics
NPI:1225137359
Name:KO SURGICAL ASSOCIATES P.C
Entity Type:Organization
Organization Name:KO SURGICAL ASSOCIATES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNG-TAO
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-833-0386
Mailing Address - Street 1:130 S MAIN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2670
Mailing Address - Country:US
Mailing Address - Phone:630-620-6040
Mailing Address - Fax:630-620-6143
Practice Address - Street 1:130 S MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2670
Practice Address - Country:US
Practice Address - Phone:630-620-6040
Practice Address - Fax:630-620-6143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-045253Medicaid
IL0002215295OtherBLUE CROSS
IL720440Medicare ID - Type Unspecified
IL036-045253Medicaid