Provider Demographics
NPI:1376759605
Name:RICHARD E. LIND, MD SC
Entity Type:Organization
Organization Name:RICHARD E. LIND, MD SC
Other - Org Name:SURGICAL ASSOCIATES OF FOX VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-455-2752
Mailing Address - Street 1:690 E TERRA COTTA AVE
Mailing Address - Street 2:SIUTE A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3605
Mailing Address - Country:US
Mailing Address - Phone:815-455-2752
Mailing Address - Fax:815-455-2789
Practice Address - Street 1:690 E TERRA COTTA AVE
Practice Address - Street 2:SIUTE A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3605
Practice Address - Country:US
Practice Address - Phone:815-455-2752
Practice Address - Fax:815-455-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.005720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty