Provider Demographics
NPI:1952633836
Name:MIDWEST CYGNETAZURE, INC
Entity Type:Organization
Organization Name:MIDWEST CYGNETAZURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GUDRUN
Authorized Official - Middle Name:VIGDIS
Authorized Official - Last Name:JONSDOTTIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-458-0625
Mailing Address - Street 1:1474 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5917
Mailing Address - Country:US
Mailing Address - Phone:847-458-0625
Mailing Address - Fax:847-458-8822
Practice Address - Street 1:1474 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5917
Practice Address - Country:US
Practice Address - Phone:847-458-0625
Practice Address - Fax:847-458-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical