# KENILWORTH SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fenner Ambulatory Surgical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134591191
- **Authorized official:** GEOFFREY C FENNER MD (PHYSICIAN/OWNER)
- **Authorized official phone:** (847) 716-2400

## Contact information

- **Practice address:** 512 GREEN BAY RD, KENILWORTH, IL 60043-1073
- **Practice address phone:** (847) 716-2400
- **Practice address fax:** (847) 716-2441
- **Mailing address:** 512 GREEN BAY RD, KENILWORTH, IL 60043-1073
- **Mailing address phone:** (847) 716-2400
- **Mailing address fax:** (847) 716-2441

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/29/2015
- **Last updated:** 07/21/2022