Organization
TIESENGA SURGICAL ASSOCIATES, S.C.
Active
Other names
Suburban Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN BURDETT (ADMINISTRATIVE ASSISTANT)
(708) 453-6800
Entity
Organization
Contact information
Practice address
1950 N HARLEM AVE, ELMWOOD PARK, IL 60707
(708) 453-6800
(708) 453-3985
Mailing address
1950 N HARLEM AVE, ELMWOOD PARK, IL 60707
(708) 453-6800
(708) 453-3985
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
042000966
IL
2086S0129X
Vascular Surgery Physician
042000966
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0160377350
BCBS
IL
01
—
950730
MEDICARE PRACTICE
IL
01
—
CI4143
RR MCR
IL
Enumeration date
01/19/2006
Last updated
10/18/2022
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