Organization
1915-25 95TH ST., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAVISH SHAH (OFFICE MANAGER)
(630) 571-1100
Entity
Organization
Contact information
Practice address
1915 E 95TH ST, CHICAGO, IL 60617
(630) 571-1100
(630) 504-6265
Mailing address
1915 E 95TH STREET, CHICAGO, IL 60617
(630) 571-1100
(630) 504-6265
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
04/12/2017
Last updated
04/12/2017
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