Provider Demographics
NPI:1821104076
Name:UNIVERSITY SURGICAL CONSULTANTS SC
Entity Type:Organization
Organization Name:UNIVERSITY SURGICAL CONSULTANTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ISA
Authorized Official - Last Name:SALTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-561-7710
Mailing Address - Street 1:5011 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2611
Mailing Address - Country:US
Mailing Address - Phone:773-561-7710
Mailing Address - Fax:773-561-7760
Practice Address - Street 1:5011 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2611
Practice Address - Country:US
Practice Address - Phone:773-561-7710
Practice Address - Fax:773-561-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP11203Medicare UPIN