Provider Demographics
NPI:1235663782
Name:MIDWEST SURGERY AND ONCOLOGY CONSULTANTS LLC
Entity Type:Organization
Organization Name:MIDWEST SURGERY AND ONCOLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVIN
Authorized Official - Middle Name:CHANDRAKANT
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:815-582-3177
Mailing Address - Street 1:1435 KALLIEN AVE.
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:402-547-7009
Mailing Address - Fax:
Practice Address - Street 1:301 MADISON ST STE 302
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6995
Practice Address - Country:US
Practice Address - Phone:815-582-3177
Practice Address - Fax:815-582-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.138823208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036138823Medicaid