Provider Demographics
NPI:1467470930
Name:33RD STREET SURGERY CENTER LLC
Entity Type:Organization
Organization Name:33RD STREET SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SHIKANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-554-4455
Mailing Address - Street 1:200 E. 33RD ST
Mailing Address - Street 2:SUITE 631
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-554-4455
Mailing Address - Fax:410-554-2839
Practice Address - Street 1:200 E. 33RD ST.
Practice Address - Street 2:SUITE 631
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-554-4455
Practice Address - Fax:410-554-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35559207Y00000X
MDD0057335207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404565300Medicaid
MD1356522OtherCIGNA
MD7441931OtherMDIPA/OPTIMUM CHOICE
MD0007456615OtherAETNA
MD404565300Medicaid