Provider Demographics
NPI:1356437578
Name:UROLOGICAL SURGEONS OF ILLINOIS, LTD
Entity type:Organization
Organization Name:UROLOGICAL SURGEONS OF ILLINOIS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SLUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-937-4006
Mailing Address - Street 1:375 N WALL ST
Mailing Address - Street 2:SUITE P530
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-937-4006
Mailing Address - Fax:815-937-3850
Practice Address - Street 1:375 N WALL ST
Practice Address - Street 2:SUITE P530
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3483
Practice Address - Country:US
Practice Address - Phone:815-937-4006
Practice Address - Fax:815-937-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL646531Medicare ID - Type Unspecified
IL646534Medicare ID - Type Unspecified
IL646533Medicare ID - Type Unspecified