# CUSTOM SURGICAL CARE LLC

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

## Provider details

- **NPI number:** 1639923824
- **Authorized official:** MARIA OSIPOVA MD (PRESIDENT)
- **Authorized official phone:** (773) 551-5776

## Contact information

- **Practice address:** 2350 RAVINE WAY STE 400, GLENVIEW, IL 60025-7621
- **Practice address phone:** (847) 232-4843
- **Practice address fax:** (847) 779-6877
- **Mailing address:** 1S376 SUMMIT AVE STE 4C, OAKBROOK TERRACE, IL 60181-3966
- **Mailing address phone:** (847) 232-4843
- **Mailing address fax:** (847) 779-6877

## Taxonomy

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

## Other

- **Enumeration date:** 04/15/2024
- **Last updated:** 04/15/2024