Provider Demographics
NPI:1497971709
Name:DELIJAN SURGICAL ASSISTANTS, INC.
Entity Type:Organization
Organization Name:DELIJAN SURGICAL ASSISTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAKOLY
Authorized Official - Suffix:
Authorized Official - Credentials:RCSA
Authorized Official - Phone:630-759-9070
Mailing Address - Street 1:P.O.BOX 9274
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-9274
Mailing Address - Country:US
Mailing Address - Phone:630-759-9070
Mailing Address - Fax:630-759-9067
Practice Address - Street 1:101 ROYCE ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1458
Practice Address - Country:US
Practice Address - Phone:630-759-9070
Practice Address - Fax:630-759-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty