Provider Demographics
NPI:1699008706
Name:S. O. GROUP, S.C.
Entity Type:Organization
Organization Name:S. O. GROUP, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-2302
Mailing Address - Street 1:1725 W. HARRISON STREET
Mailing Address - Street 2:SUITE 409
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-942-2302
Mailing Address - Fax:312-563-2228
Practice Address - Street 1:1725 W. HARRISON STREET
Practice Address - Street 2:SUITE 409
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-2302
Practice Address - Fax:312-563-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.006019208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty