Provider Demographics
NPI:1043501448
Name:METRO CHICAGO SURGICAL ONCOLOGY LLC
Entity type:Organization
Organization Name:METRO CHICAGO SURGICAL ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-673-6505
Mailing Address - Street 1:3201 OLD GLENVIEW RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2999
Mailing Address - Country:US
Mailing Address - Phone:847-673-6505
Mailing Address - Fax:847-673-2099
Practice Address - Street 1:3201 OLD GLENVIEW RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2999
Practice Address - Country:US
Practice Address - Phone:847-673-6505
Practice Address - Fax:847-673-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036080243207VG0400X
IL036058459208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43962Medicare UPIN
IL616141Medicare PIN