Provider Demographics
NPI:1689001414
Name:MEDICAL SURGICAL GROUP
Entity Type:Organization
Organization Name:MEDICAL SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:7733-810-0380
Mailing Address - Street 1:7456 S STATE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60638-6623
Mailing Address - Country:US
Mailing Address - Phone:773-382-0380
Mailing Address - Fax:
Practice Address - Street 1:7456 S STATE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60638-6623
Practice Address - Country:US
Practice Address - Phone:773-382-0380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-13
Last Update Date:2013-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-075843261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care