Provider Demographics
NPI:1598379075
Name:CENTRAL DUPAGE SURGICAL, INC
Entity Type:Organization
Organization Name:CENTRAL DUPAGE SURGICAL, INC
Other - Org Name:CENTRAL DUPAGE SURGICAL, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DR. ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRCHNER-GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-233-8343
Mailing Address - Street 1:800 W ARMY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9040
Mailing Address - Country:US
Mailing Address - Phone:630-233-8343
Mailing Address - Fax:630-233-8346
Practice Address - Street 1:800 W ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-9040
Practice Address - Country:US
Practice Address - Phone:630-233-8343
Practice Address - Fax:630-233-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty