Provider Demographics
NPI:1487761359
Name:S.T. SURGICAL CONSULTANTS
Entity type:Organization
Organization Name:S.T. SURGICAL CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-561-7911
Mailing Address - Street 1:2845 N SHERIDAN ROAD
Mailing Address - Street 2:SUITE 714
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-561-7911
Mailing Address - Fax:773-561-7760
Practice Address - Street 1:2845 N SHERIDAN ROAD
Practice Address - Street 2:SUITE 714
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-561-7911
Practice Address - Fax:773-561-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125508Medicaid
IL36058530Medicaid
IL36130078Medicaid
IL36140559Medicaid
IL36114923Medicaid
IL36128507Medicaid