Provider Demographics
NPI:1346396728
Name:SURGICAL CONSULTANTS OF DUPAGE
Entity Type:Organization
Organization Name:SURGICAL CONSULTANTS OF DUPAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-325-3310
Mailing Address - Street 1:908 N ELM ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3635
Mailing Address - Country:US
Mailing Address - Phone:630-325-3310
Mailing Address - Fax:630-325-9163
Practice Address - Street 1:908 N ELM ST
Practice Address - Street 2:SUITE 310
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3635
Practice Address - Country:US
Practice Address - Phone:630-325-3310
Practice Address - Fax:630-325-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095786208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002220321OtherBCBS GROUP PROVIDER NUM
ILCD5773OtherRR MEDICARE
IL216228Medicare PIN