# RIVER NORTH SURGICAL SUITE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164541025
- **Authorized official:** MS. LESLIE NANCY MEJIA (BILLING MANAGER)
- **Authorized official phone:** (312) 337-9900

## Contact information

- **Practice address:** 467 W ERIE ST, CHICAGO, IL 60610-4004
- **Practice address phone:** (312) 337-9900
- **Practice address fax:** (312) 337-9902
- **Mailing address:** 467 W ERIE ST, CHICAGO, IL 60610-4004
- **Mailing address phone:** (312) 337-9900
- **Mailing address fax:** (312) 337-9902

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 06005134 | IL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | IL | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 08/22/2020