Provider Demographics
NPI:1558920579
Name:LASER SPINE SURGICAL SOLUTIONS
Entity Type:Organization
Organization Name:LASER SPINE SURGICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUSHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-460-9000
Mailing Address - Street 1:16604 107TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8898
Mailing Address - Country:US
Mailing Address - Phone:708-966-8000
Mailing Address - Fax:708-460-0094
Practice Address - Street 1:16604 107TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8898
Practice Address - Country:US
Practice Address - Phone:708-966-8000
Practice Address - Fax:708-460-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty