Provider Demographics
NPI:1497832877
Name:DOWNERS GROVE SURGERY AND TREATMENT CENTER P C
Entity Type:Organization
Organization Name:DOWNERS GROVE SURGERY AND TREATMENT CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:REMBOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-810-9966
Mailing Address - Street 1:1228 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2740
Mailing Address - Country:US
Mailing Address - Phone:630-810-9966
Mailing Address - Fax:630-810-9596
Practice Address - Street 1:1228 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2740
Practice Address - Country:US
Practice Address - Phone:630-810-9966
Practice Address - Fax:630-810-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060009245213ES0103X
IL016004313213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T87676Medicare UPIN
IL936480Medicare ID - Type Unspecified