Provider Demographics
NPI:1457543571
Name:DES PLAINES SURGICARE INC
Entity Type:Organization
Organization Name:DES PLAINES SURGICARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-296-5470
Mailing Address - Street 1:8901 GOLF RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6850
Mailing Address - Country:US
Mailing Address - Phone:847-296-5470
Mailing Address - Fax:847-296-5474
Practice Address - Street 1:8901 GOLF RD
Practice Address - Street 2:SUITE 204
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6850
Practice Address - Country:US
Practice Address - Phone:847-296-5470
Practice Address - Fax:847-296-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical