Provider Demographics
NPI:1023116233
Name:UNIVERSITY THORACIC SURGEONS
Entity type:Organization
Organization Name:UNIVERSITY THORACIC SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-563-4334
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 774
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-942-6725
Mailing Address - Fax:312-942-6730
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 774
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-6725
Practice Address - Fax:312-942-6730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH UNIVERSITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636661OtherBC GROUP #
IL214160Medicare PIN