Provider Demographics
NPI:1780830307
Name:MIDWEST SURGICAL FACILITY
Entity Type:Organization
Organization Name:MIDWEST SURGICAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:VOHRA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-892-0000
Mailing Address - Street 1:1851 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-2159
Mailing Address - Country:US
Mailing Address - Phone:630-892-0000
Mailing Address - Fax:630-892-0000
Practice Address - Street 1:1851 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-2159
Practice Address - Country:US
Practice Address - Phone:630-892-0000
Practice Address - Fax:630-892-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004798261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL245080Medicare PIN