Organization
MIDWEST SURGICAL ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN ANN HAGEN M.D. (PRESIDENT)
(708) 579-9705
Entity
Organization
Contact information
Practice address
5201 WILLOW SPRINGS RD, SUITE 180, LA GRANGE HIGHLANDS, IL 60525-6537
(708) 579-9705
(708) 579-0346
Mailing address
5201 WILLOW SPRINGS RD, SUITE 180, LA GRANGE HIGHLANDS, IL 60525-6537
(708) 579-9705
(708) 579-0346
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036-053291
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273425786603013
—
IL
01
—
31600057
BC BS
IL
Enumeration date
02/22/2007
Last updated
07/29/2013
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