# ILLINI SURGICAL ASSOCIATES, INC

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

## Provider details

- **NPI number:** 1437231446
- **Authorized official:** MR. KEITH ALLEN PENROD RSA (PRESIDENT)
- **Authorized official phone:** (630) 795-1855

## Contact information

- **Practice address:** 6809 ARMSTRONG CT, WOODRIDGE, IL 60517-1526
- **Practice address phone:** (630) 795-1855
- **Practice address fax:** (630) 795-1844
- **Mailing address:** PO BOX 5306, WOODRIDGE, IL 60517-0306
- **Mailing address phone:** (630) 795-1855
- **Mailing address fax:** (630) 795-1844

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | IL | Yes |

## Other

- **Enumeration date:** 10/19/2006
- **Last updated:** 08/29/2007