Western Avenue Surgical Associates, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WESTERN AVENUE SURGICAL ASSOCIATES, LLC

Practice address

712 N Dearborn St
Chicago, IL 60654-3818

Phone

(312) 981-1297

NPI assigned

Apr 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gary Wiesman, M.D.

Title

Co-Owner

Phone

(312) 981-1297

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1285859595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 N DEARBORN ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606543818",
            "telephone_number": "312-981-1297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 N DEARBORN ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606543818",
            "telephone_number": "312-981-1297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN AVENUE SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2009-05-06",
        "status": "A",
        "authorized_official_last_name": "WIESMAN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "312-981-1297",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Chicago, IL
• Providers in Chicago, 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 May 6, 2009; 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.