Provider Demographics
NPI:1932480506
Name:MEDICINE & SURGERY SC
Entity Type:Organization
Organization Name:MEDICINE & SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOLEHIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-779-7500
Mailing Address - Street 1:11250 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4116
Mailing Address - Country:US
Mailing Address - Phone:773-779-7500
Mailing Address - Fax:
Practice Address - Street 1:11250 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4116
Practice Address - Country:US
Practice Address - Phone:773-779-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081654207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty