Provider Demographics
NPI:1598090870
Name:CARDINAL SURGICAL ASSOCIATES S C
Entity Type:Organization
Organization Name:CARDINAL SURGICAL ASSOCIATES S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-730-0202
Mailing Address - Street 1:1051 ESSINGTON RD
Mailing Address - Street 2:SUITE 230A
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2892
Mailing Address - Country:US
Mailing Address - Phone:815-730-0202
Mailing Address - Fax:
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 230A
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2892
Practice Address - Country:US
Practice Address - Phone:815-730-0202
Practice Address - Fax:815-730-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118697208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09933057OtherBCBS
ILDP8067OtherRAILROAD MEDICARE
IL036118697Medicaid
ILIL2735Medicare PIN