MEDICARE: CHICAGO MUSCULOSKELETAL INSTITUTE, S.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	261QM1300X	Multi-Specialty Clinic/Center	036105713	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528153335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO MUSCULOSKELETAL INSTITUTE, S.C.

Provider Business Mailing Address
First Line	:	PO BOX 411303
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-1303
Country	:	US
Telephone Number	:	773-675-9900
Fax Number	:	800-281-6952

Provider Business Practice Location Address
First Line	:	5645 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4403
Country	:	US
Telephone Number	:	217-341-3935
Fax Number	:	800-281-6952

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL T IVANKOVICH
Credential	:	M.D.
Telephone Number	:	217-341-3935

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/20/2026

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Directions to “CHICAGO MUSCULOSKELETAL INSTITUTE, S.C. ” Practice Location

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