Provider Demographics
NPI:1932136389
Name:SURGERY CENTER AT 900 N MICHIGAN AVE LLC
Entity Type:Organization
Organization Name:SURGERY CENTER AT 900 N MICHIGAN AVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZORGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-440-5150
Mailing Address - Street 1:PO BOX 88185
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-8185
Mailing Address - Country:US
Mailing Address - Phone:312-440-5150
Mailing Address - Fax:877-235-5009
Practice Address - Street 1:60 E DELAWARE PL
Practice Address - Street 2:15TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1898
Practice Address - Country:US
Practice Address - Phone:312-440-5150
Practice Address - Fax:312-440-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL538810Medicare ID - Type UnspecifiedMEDICARE PART B