Provider Demographics
NPI:1861770182
Name:SURGICAL PARTNERS
Entity type:Organization
Organization Name:SURGICAL PARTNERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YASER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAKSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-731-4949
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:SURGICAL PARTNERS
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-0437
Mailing Address - Country:US
Mailing Address - Phone:312-731-4949
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:ADVOCATE MEDICAL GROUP - SURGICAL PARTNERS
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:312-731-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000220363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty