Provider Demographics
NPI:1760772750
Name:ELGIN SURGICARE LLC
Entity Type:Organization
Organization Name:ELGIN SURGICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-888-7423
Mailing Address - Street 1:1554 TODD FARM DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-1287
Mailing Address - Country:US
Mailing Address - Phone:847-888-7423
Mailing Address - Fax:
Practice Address - Street 1:1554 TODD FARM DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1287
Practice Address - Country:US
Practice Address - Phone:847-888-7423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical