NPIMap

Organization Active NPI

Trauma and Surgical Specialists of Dupage, LLC

  • Surgery Physician
  • Downers Grove, IL
National Provider Identifier
1003968157
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
TRAUMA AND SURGICAL SPECIALISTS OF DUPAGE, LLC
Practice address
3815 Highland Ave
Tower 2, Suite 107
Downers Grove, IL 60515-1500
Phone
(630) 275-7800
Fax
(630) 810-9240
NPI assigned
Jan 17, 2007
Last updated
Oct 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael J. Iwanicki, D.O.NPI 1003845561
Title
Owner
Phone
(603) 275-3892

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X Primary
Trauma Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086S0127X

Addresses

Primary practice location

3815 Highland Ave
Tower 2, Suite 107
Downers Grove, IL 60515-1500

Mailing address

3815 Highland Ave
Tower 2, Suite 107
Downers Grove, IL 60515-1500
Phone (630) 275-7800

National Provider Directory

National Provider Directory

Locations

Dept 4572
Carol Stream, IL 60122

3815 Highland Ave
Ste 107
Downers Grove, IL 60515
Phone (630) 275-3540

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318550400000",
    "number": "1003968157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 HIGHLAND AVE",
            "address_2": "TOWER 2, SUITE 107",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151500",
            "telephone_number": "630-275-7800",
            "fax_number": "630-810-9240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 HIGHLAND AVE",
            "address_2": "TOWER 2, SUITE 107",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151500",
            "telephone_number": "630-275-7800",
            "fax_number": "630-810-9240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAUMA AND SURGICAL SPECIALISTS OF DUPAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2011-10-14",
        "status": "A",
        "authorized_official_last_name": "IWANICKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-275-3892",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downers Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.