Organization
ILLINOIS SURGEON ASSOCIATION LLC
Active
Other names
ISA DOH
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MANDAN FARAHATI M.D. (COO)
(312) 787-2998
Entity
Organization
Contact information
Practice address
60 E DELAWARE PL FL 15, CHICAGO, IL 60611-1676
(312) 787-2998
(312) 787-7259
Mailing address
PO BOX 10523, CHICAGO, IL 60610-0523
(312) 787-2998
(312) 787-7259
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.004756
IL
Other
Enumeration date
03/08/2011
Last updated
04/14/2011
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