# 1915-25 95TH ST., LLC

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

## Provider details

- **NPI number:** 1447784921
- **Authorized official:** MR. RAVISH SHAH (OFFICE MANAGER)
- **Authorized official phone:** (630) 571-1100

## Contact information

- **Practice address:** 1915 E 95TH ST, CHICAGO, IL 60617
- **Practice address phone:** (630) 571-1100
- **Practice address fax:** (630) 504-6265
- **Mailing address:** 1915 E 95TH STREET, CHICAGO, IL 60617
- **Mailing address phone:** (630) 571-1100
- **Mailing address fax:** (630) 504-6265

## Taxonomy

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

## Other

- **Enumeration date:** 04/12/2017
- **Last updated:** 04/12/2017