# WESTERN AVENUE SURGICAL ASSOCIATES, LLC

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

## Provider details

- **NPI number:** 1285859595
- **Authorized official:** DR. GARY WIESMAN M.D. (CO-OWNER)
- **Authorized official phone:** (312) 981-1297

## Contact information

- **Practice address:** 712 N DEARBORN ST, CHICAGO, IL 60654-3818
- **Practice address phone:** (312) 981-1297
- **Mailing address:** 712 N DEARBORN ST, CHICAGO, IL 60654-3818
- **Mailing address phone:** (312) 981-1297

## Taxonomy

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

## Other

- **Enumeration date:** 04/13/2007
- **Last updated:** 05/06/2009