Provider Demographics
NPI:1477603686
Name:UROLOGICAL SURGEONS ASSOCIATED CHARTERED
Entity Type:Organization
Organization Name:UROLOGICAL SURGEONS ASSOCIATED CHARTERED
Other - Org Name:THOMAS C MALVAR MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-248-2842
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-0798
Mailing Address - Country:US
Mailing Address - Phone:847-692-6218
Mailing Address - Fax:847-692-6560
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 602
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-248-2842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046237Medicaid
CM4130OtherPALMETTO GBA
21604584OtherBC BS
IL036046237Medicaid
475950Medicare PIN