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Organization
ENTERPRISE SURGICAL ASSISTANCE
Active
Organization
ENTERPRISE SURGICAL ASSISTANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL DAVID OSTROFF M.D. (PRESIDENT)
(773) 502-4221
Entity
Organization
Contact information
Practice address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 783-7696
(773) 404-2086
Mailing address
PO BOX 56341, CHICAGO, IL 60656-0341
(708) 867-4949
(708) 867-4981
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
NULL
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01637103
BLUE CROSS BLUE SHIELD OF IL
IL
Enumeration date
05/11/2007
Last updated
12/08/2009
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