Provider Demographics
NPI:1073819165
Name:FEDERER SURGICAL SERVICES LTD
Entity type:Organization
Organization Name:FEDERER SURGICAL SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:FEDERER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:773-293-4001
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:773-293-4001
Mailing Address - Fax:
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-293-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072388208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE76781Medicare UPIN
IL927122Medicare PIN