Kenilworth Surgery LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

KENILWORTH SURGERY LLC

Practice address

512 Green Bay Rd
Kenilworth, IL 60043-1073

Phone

(847) 716-2400

Fax

(847) 716-2441

NPI assigned

Oct 29, 2015

Organization subpart

No

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

Authorized official

Name

Geoffrey C Fenner, MD

Title

Physician/Owner

Phone

(847) 716-2400

Specialties & licenses 1

Addresses

Other names 1

• Fenner Ambulatory Surgical Center Doing business as

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

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1134591191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 GREEN BAY RD",
            "city": "KENILWORTH",
            "state": "IL",
            "postal_code": "600431073",
            "telephone_number": "847-716-2400",
            "fax_number": "847-716-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 GREEN BAY RD",
            "city": "KENILWORTH",
            "state": "IL",
            "postal_code": "600431073",
            "telephone_number": "847-716-2400",
            "fax_number": "847-716-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENILWORTH SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "FENNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "847-716-2400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fenner Ambulatory Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anthony Juliano, M.A.
• Parfait Karka Kanam
• Karla E.a. Steingraber PC
• Caroline Nothman Katz, MA
• Kenilworth Medical Associates, S.C.
• Lindsey Marilyn Klepper, MSW
• Elena B. Labkovsky, PH.D.
• Sally Lankford
• Morgan Anne Lasley, PSYD
• Megann Lear, DMD, MSD

• Ambulatory Surgical Clinic/Center in Kenilworth, IL
• Providers in Kenilworth, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.