Organization
CARLOS ORTEGA MD SC
Active
Parent organization
BOFFA SURGICAL GROUP LLC
Other names
Boffa Surgical Group LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOFFA SURGICAL GROUP LLC
Authorized official
DR. CARLOS D ORTEGA M.D. (EMPLOYEE)
(773) 235-8887
Entity
Organization
Contact information
Practice address
5140 N CALIFORNIA AVE STE 780, CHICAGO, IL 60625-7066
(773) 235-8887
(773) 235-8882
Mailing address
5140 N CALIFORNIA AVE STE 780, CHICAGO, IL 60625-7066
(773) 235-8887
(773) 235-8882
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036100042
IL
2086S0102X
Surgical Critical Care Physician
036100042
IL
2086S0127X
Trauma Surgery Physician
036100042
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100042
—
IL
01
—
1629966
BCBS IL NIESS
IL
01
—
1630046
BCBSIL BSG
IL
Enumeration date
07/18/2006
Last updated
05/05/2011
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