Provider Demographics
NPI:1770529612
Name:GENERAL SURGEONS OF KANKAKEE LTD
Entity type:Organization
Organization Name:GENERAL SURGEONS OF KANKAKEE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-932-0911
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:375 N WALL ST
Practice Address - Street 2:SUITE P640
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3483
Practice Address - Country:US
Practice Address - Phone:815-932-0911
Practice Address - Fax:815-932-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF2109OtherRAILROAD MEDICARE
IL4615036OtherBCBS PROVIDER ID
IL123451234567OtherHEALTHLINK INC PPO ID
IL123451234567OtherPREFERRED ONE ID
IL123451234567OtherHEALTHLINK INC PPO ID
ILCF2109Medicare PIN