MEDICARE: ILLINOIS HAND & UPPER EXTREMITY CENTER, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1265737621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS HAND & UPPER EXTREMITY CENTER, L.L.C.

Provider Business Mailing Address
First Line	:	515 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4405
Country	:	US
Telephone Number	:	847-956-0099
Fax Number	:	847-956-0433

Provider Business Practice Location Address
First Line	:	515 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4405
Country	:	US
Telephone Number	:	847-956-0099
Fax Number	:	847-956-0433

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. MICHAEL I VENDER
Credential	:	M.D.
Telephone Number	:	847-956-0099

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	01/17/2011

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