Organization
ELGIN SURGICARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANIA KHAMOO (ADMINISTRATOR)
(773) 309-6740
Entity
Organization
Contact information
Practice address
521 W CHICAGO AVE, EAST CHICAGO, IN 46312-3206
(630) 345-0834
Mailing address
4941 N KEDZIE AVE, CHICAGO, IL 60625-5009
(773) 509-9099
(773) 509-9006
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01077720A
IN
207R00000X
Internal Medicine Physician
1952663593
IN
Other
Enumeration date
05/31/2017
Last updated
03/17/2018
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