# ENTERPRISE SURGICAL ASSISTANCE

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

## Provider details

- **NPI number:** 1992910988
- **Authorized official:** DR. RANDALL DAVID OSTROFF M.D. (PRESIDENT)
- **Authorized official phone:** (773) 502-4221

## Contact information

- **Practice address:** 3249 OAK PARK AVE, BERWYN, IL 60402-3429
- **Practice address phone:** (708) 783-7696
- **Practice address fax:** (773) 404-2086
- **Mailing address:** PO BOX 56341, CHICAGO, IL 60656-0341
- **Mailing address phone:** (708) 867-4949
- **Mailing address fax:** (708) 867-4981

## Taxonomy

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

## Other

- **Enumeration date:** 05/11/2007
- **Last updated:** 12/08/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01637103 | BLUE CROSS BLUE SHIELD OF IL | IL |