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Organization

SURGICAL ASSOCIATES OF BLOOMINGTON, ILL,LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAWRENCE A. RAINES MD (PRESIDENT)
(309) 663-4351
Entity
Organization

Contact information

Practice address
1404 EASTLAND DRIVE, SUITE 104, BLOOMINGTON, IL 61701
(309) 663-4351
(309) 663-8359
Mailing address
1404 EASTLAND DRIVE, SUITE 104, BLOOMINGTON, IL 61701
(309) 663-4351
(309) 663-8359

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary

Other

Enumeration date
09/14/2006
Last updated
02/01/2011
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