Provider Demographics
NPI:1245335744
Name:AKI AND KROCZEK SURGICAL ASSOCIATES, LTD.
Entity type:Organization
Organization Name:AKI AND KROCZEK SURGICAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-763-1234
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-763-1234
Mailing Address - Fax:773-631-1650
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 221
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-763-1234
Practice Address - Fax:773-631-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074391208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-096989Medicaid
ILCN7023OtherRR MEDICARE PTAN
IL036-074391Medicaid
ILC43318Medicare UPIN
IL036-096989Medicaid
ILCN7023OtherRR MEDICARE PTAN
IL036-074391Medicaid