Provider Demographics
NPI:1619086824
Name:WEST SUBURBAN HEAD AND NECK SPECIALISTS,S.C.
Entity Type:Organization
Organization Name:WEST SUBURBAN HEAD AND NECK SPECIALISTS,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-345-5549
Mailing Address - Street 1:1111 SUPERIOR ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4138
Mailing Address - Country:US
Mailing Address - Phone:708-345-5549
Mailing Address - Fax:708-345-5589
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 411
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-345-5549
Practice Address - Fax:708-345-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622862OtherGROUP NUMBER
IL259060Medicare ID - Type UnspecifiedGROUP NUMBER
IL01622862OtherGROUP NUMBER