Provider Demographics
NPI:1528114501
Name:CDN SURGICAL ASSOC., LTD.
Entity type:Organization
Organization Name:CDN SURGICAL ASSOC., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:URSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-763-3445
Mailing Address - Street 1:PO BOX 597995
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60695-0001
Mailing Address - Country:US
Mailing Address - Phone:773-472-3427
Mailing Address - Fax:773-472-8561
Practice Address - Street 1:2913 N COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6211
Practice Address - Country:US
Practice Address - Phone:773-472-3427
Practice Address - Fax:773-472-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086X0206X, 208C00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA6608OtherMEDICARE RAILROAD PART B
IL0001618161OtherBC BS OF IL GROUP NUMBER
IL0001618161OtherBC BS OF IL GROUP NUMBER