Illinois Surgeon Association LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.004756 Issued in IL

Legal business name

ILLINOIS SURGEON ASSOCIATION LLC

Practice address

60 E Delaware PL FL 15
Chicago, IL 60611-1676

Phone

(312) 787-2998

Fax

(312) 787-7259

NPI assigned

Mar 8, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Mandan Farahati, M.D.

Title

Coo

Phone

(312) 787-2998

Specialties & licenses 1

Addresses

Other names 1

• ISA DOH Other name

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

{
    "created_epoch": "1299542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302739200000",
    "number": "1649578105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10523",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606100523",
            "telephone_number": "312-787-2998",
            "fax_number": "312-787-7259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 E DELAWARE PL FL 15",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606111676",
            "telephone_number": "312-787-2998",
            "fax_number": "312-787-7259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS SURGEON ASSOCIATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-08",
        "last_updated": "2011-04-14",
        "status": "A",
        "authorized_official_last_name": "FARAHATI",
        "authorized_official_first_name": "MANDAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "312-787-2998",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.004756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ISA DOH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Registered Dietitian in Chicago, IL
• Providers in Chicago, IL by specialty
• Registered Dietitian in Illinois

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