Provider Demographics
NPI:1831115583
Name:NORTHERN ILLINOIS AMBULATORY SERVICE LLC
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS AMBULATORY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KONOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-921-9733
Mailing Address - Street 1:1121 LAKE COOK ROAD
Mailing Address - Street 2:SUITE M
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5234
Mailing Address - Country:US
Mailing Address - Phone:847-945-4550
Mailing Address - Fax:847-948-8103
Practice Address - Street 1:404 MCHENRY RD.
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6740
Practice Address - Country:US
Practice Address - Phone:847-821-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical