Provider Demographics
NPI:1336106442
Name:METROPOLITAN SURGICAL ASSOC INC
Entity Type:Organization
Organization Name:METROPOLITAN SURGICAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ- TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-567-2199
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:2ND FLOOR, DOCTORS OFFICE CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2199
Practice Address - Fax:312-328-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21622027OtherBCBS PROVIDER ID
ILCG5826OtherRAILROAD MEDICARE
ILCK2946OtherRAILROAD MEDICARE
ILCK2946Medicare PIN
ILCG5826OtherRAILROAD MEDICARE
IL486680Medicare PIN
ILCG5826Medicare PIN