Provider Demographics
NPI:1861589020
Name:NORTHERN ILLINOIS EMERGENCY SURGICAL SERV LTD
Entity type:Organization
Organization Name:NORTHERN ILLINOIS EMERGENCY SURGICAL SERV LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:RASPANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-867-4949
Mailing Address - Street 1:PO BOX 56341
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-0341
Mailing Address - Country:US
Mailing Address - Phone:708-867-4949
Mailing Address - Fax:708-867-4981
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:708-867-4949
Practice Address - Fax:708-867-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001629966OtherBC BS OF IL GROUP NUMBER
IL001629966OtherBC BS OF IL GROUP NUMBER
ILDB3425Medicare PIN