Provider Demographics
NPI:1790150241
Name:ORTHO SPINE SURGICAL LLC
Entity Type:Organization
Organization Name:ORTHO SPINE SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-571-1100
Mailing Address - Street 1:534 CHESTNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3175
Mailing Address - Country:US
Mailing Address - Phone:630-571-1100
Mailing Address - Fax:
Practice Address - Street 1:534 CHESTNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3175
Practice Address - Country:US
Practice Address - Phone:630-571-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical