Unknown Individual – Vascular Surgery Physician, NPI 1114014693

Unknown Individual is a healthcare provider. based in Orland park, Illinois. specializing in Vascular Surgery Physician. They hold a License No. MD444899 (PA). The NPI Number for Unknown Individual is 1114014693

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114014693
Phone
(708) 226-2623
Address
15300 WEST AVE
Deactivation Date
16 April 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3604794203
Graduation Year
1983 (43 years ago)
PAC ID
2264493576
Group Practice PAC ID
0547173866
Professional Enrollment ID
I20190613000178
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience40
Completeness75
Years active:0State licenses:7Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Palos Health Surgery Center, 15300, West Avenue, Orland Park, Orland Township, Cook County, Illinois, 60467, United States

    SUITE 22 S.

    ORLAND PARK, IL 604624600

    Phone: (708) 226-2623

    Fax: (708) 226-2423

    Type: Mailing

  • 12255, South 80th Avenue, Palos Heights, Palos Township, Cook County, Illinois, 60464, United States

    SUITE 203

    PALOS HEIGHTS, IL 604631270

    Phone: (708) 923-7870

    Fax: (708) 226-2423

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60462)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0547173866View full group profile
NameSpecialtyState
DAWN EWING GALVEZ (FNP-C)
-SC
MRS. TIFFANY C CRABB (PA-C)
Physician AssistantWA
MS. GRETCHEN CORNWALL BERNI (ARNP)
-WA
DR. DEEPALI JAIN (MD)
General SurgeryMI
DR. FRANSJE JEREONTJE SLOTHOUBER GILES (DNP, NP-C)
-WA
LARA KIM (ARNP)
Nurse PractitionerWA
DAVID R BHASKAR (MD)
-WI
JOHN JOSEPH CORRALES-DIAZ (MD)
-WA
LYNN A CLARK (ARNP)
-WA
DR. SHERI LYNN PETERSON-BUCKLEY (MD)
Family PracticeWA

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1114014693 if you need a stable reference for Unknown Individual.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Vascular Surgery Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Illinois?
You will see Orland Park, Illinois on file for Unknown Individual alongside any extra practice locations.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1114014693. Always confirm identity and privileges with the practice and licensing boards.