Organization
THORACIC SURGICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL GORDON MD (PRESIDENT)
(708) 346-4065
Entity
Organization
Contact information
Practice address
10604 SOUTHWEST HIGHWAY, SUITE 101, CHICAGO RIDGE, IL 60415
(708) 346-4065
(708) 423-5799
Mailing address
10604 SOUTHWEST HIGHWAY, SUITE 101, CHICAGO RIDGE, IL 60415
(708) 346-4065
(708) 423-5799
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
PENDING
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
IL LICENSE
IL
Enumeration date
05/17/2018
Last updated
05/17/2018
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