Provider Demographics
NPI:1700117504
Name:SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ATIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-302-8396
Mailing Address - Street 1:7630 LINCOLN MILL RD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-7006
Mailing Address - Country:US
Mailing Address - Phone:219-771-3740
Mailing Address - Fax:219-942-2276
Practice Address - Street 1:600 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-6001
Practice Address - Country:US
Practice Address - Phone:219-302-8396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062340B281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN267630AOtherINDIVIDUAL MEDICARE PIN
IN000000561613OtherBLUE CROSS BLUE SHIELD
IN200846010OtherINDIVIDUAL MEDICAID
IN200982290Medicaid
IN267630AOtherINDIVIDUAL MEDICARE PIN
IN267630Medicare PIN