Provider Demographics
NPI:1790904977
Name:LURIE SURGICAL SERVICES PC
Entity Type:Organization
Organization Name:LURIE SURGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-576-1102
Mailing Address - Street 1:1400 FOREST GLEN RD
Mailing Address - Street 2:SUITE #225
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1459
Mailing Address - Country:US
Mailing Address - Phone:301-576-1102
Mailing Address - Fax:240-641-5175
Practice Address - Street 1:1400 FOREST GLEN RD
Practice Address - Street 2:SUITE #225
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1459
Practice Address - Country:US
Practice Address - Phone:301-576-1102
Practice Address - Fax:240-641-5175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36631208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE22186Medicare UPIN
MDG02467Medicare PIN