Organization
NORTHWEST ADVANCED SURGICAL ASSOCIATES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SPIROS GIANNOULIAS MD (DIRECTOR)
(773) 478-5600
Entity
Organization
Contact information
Practice address
6374 N LINCOLN AVE, SUITE 301, CHICAGO, IL 60659-1275
(773) 478-5600
(773) 478-5602
Mailing address
6374 N LINCOLN AVE, SUITE 301, CHICAGO, IL 60659-1275
(773) 478-5600
(773) 478-5602
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01620367
BCBS
IL
01
—
14D0907680
CLIA
IL
01
—
CC3272
RAILROAD MEDICARE
IL
Enumeration date
07/30/2006
Last updated
01/31/2011
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