Provider Demographics
NPI:1154560308
Name:SURGICAL CENTER OF OAKBROOK TERRACE
Entity type:Organization
Organization Name:SURGICAL CENTER OF OAKBROOK TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:COSCINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-261-9500
Mailing Address - Street 1:1S067 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3978
Mailing Address - Country:US
Mailing Address - Phone:630-261-9500
Mailing Address - Fax:630-261-9504
Practice Address - Street 1:1S067 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3978
Practice Address - Country:US
Practice Address - Phone:630-261-9500
Practice Address - Fax:630-261-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004563261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric