Organization
AFFILIATED SURGEONS OF ROCKFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL J KLAZURA M.D. (CONTROLLING PARTNER)
(815) 489-6034
Entity
Organization
Contact information
Practice address
2300 N ROCKTON AVE, STE 304, ROCKFORD, IL 61103-3619
(815) 964-3333
(815) 964-3134
Mailing address
PO BOX 15730, LOVES PARK, IL 61132-5730
(815) 964-3333
(815) 964-3134
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
036104533
IL
208600000X
Surgery Physician
036048085
IL
208600000X
Surgery Physician
Primary
036062833
IL
208600000X
Surgery Physician
036064323
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
036071666
IL
2086S0129X
Vascular Surgery Physician
036063647
IL
2086S0129X
Vascular Surgery Physician
036067268
IL
2086S0129X
Vascular Surgery Physician
036101179
IL
208C00000X
Colon & Rectal Surgery Physician
036064410
IL
363AS0400X
Surgical Physician Assistant
085002211
IL
363L00000X
Nurse Practitioner
209004303
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10132011
BCBS GROUP NUMBER
IL
01
—
204575400
OWCP GROUP NUMBER
IL
Enumeration date
05/24/2005
Last updated
02/17/2012
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