Provider Demographics
NPI:1174622971
Name:SURGICAL PRACTICE, LTD
Entity type:Organization
Organization Name:SURGICAL PRACTICE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-527-6300
Mailing Address - Street 1:1980 THREE FARMS AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1135
Mailing Address - Country:US
Mailing Address - Phone:630-527-6300
Mailing Address - Fax:630-527-6307
Practice Address - Street 1:1980 THREE FARMS AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1135
Practice Address - Country:US
Practice Address - Phone:630-527-6300
Practice Address - Fax:630-527-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-005386208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL312540Medicare ID - Type Unspecified