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Organization
ILLINOIS SURGEON ASSOCIATION LLC
Active
Organization
ILLINOIS SURGEON ASSOCIATION LLC
Active
Other names
ISA DOH
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MANDAN FARAHATI M.D. (COO)
(312) 787-2998
Entity
Organization
Contact information
Practice address
60 E DELAWARE PL FL 15, CHICAGO, IL 60611-1676
(312) 787-2998
(312) 787-7259
Mailing address
PO BOX 10523, CHICAGO, IL 60610-0523
(312) 787-2998
(312) 787-7259
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.004756
IL
Other
Enumeration date
03/08/2011
Last updated
04/14/2011
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