Organization
ILLINI SURGICAL ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH ALLEN PENROD RSA (PRESIDENT)
(630) 795-1855
Entity
Organization
Contact information
Practice address
6809 ARMSTRONG CT, WOODRIDGE, IL 60517-1526
(630) 795-1855
(630) 795-1844
Mailing address
PO BOX 5306, WOODRIDGE, IL 60517-0306
(630) 795-1855
(630) 795-1844
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
IL
Other
Enumeration date
10/19/2006
Last updated
08/29/2007
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