Provider Demographics
NPI:1336427830
Name:MINNIHAN SURGICAL ASSISTANTS
Entity Type:Organization
Organization Name:MINNIHAN SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MINNIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:630-898-9447
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-0137
Mailing Address - Country:US
Mailing Address - Phone:630-898-9447
Mailing Address - Fax:
Practice Address - Street 1:2201 SCHRADER LN
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-2128
Practice Address - Country:US
Practice Address - Phone:630-898-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000109246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty