Provider Demographics
NPI:1336804350
Name:SKY SURGICAL
Entity Type:Organization
Organization Name:SKY SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOGESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-378-9266
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-0523
Mailing Address - Country:US
Mailing Address - Phone:920-378-9266
Mailing Address - Fax:
Practice Address - Street 1:6743 S POINTE DR UNIT 3C
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6291
Practice Address - Country:US
Practice Address - Phone:920-378-9266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty