Provider Demographics
NPI:1598907792
Name:AFFILIATED SURGICARE,LTD.
Entity Type:Organization
Organization Name:AFFILIATED SURGICARE,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NASER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-237-0755
Mailing Address - Street 1:4200 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5010
Mailing Address - Country:US
Mailing Address - Phone:773-237-0855
Mailing Address - Fax:
Practice Address - Street 1:4200 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5010
Practice Address - Country:US
Practice Address - Phone:773-237-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical