MEDICARE: WESTGATE ORTHOPAEDICS, LTD.

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	207X00000X	Orthopaedic Surgery Physician	36-37881	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	:	1639299712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTGATE ORTHOPAEDICS, LTD.

Provider Business Mailing Address
First Line	:	1125 WESTGATE ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-1007
Country	:	US
Telephone Number	:	708-848-7700
Fax Number	:	708-848-9375

Provider Business Practice Location Address
First Line	:	1125 WESTGATE ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60301-1007
Country	:	US
Telephone Number	:	708-848-7700
Fax Number	:	708-848-9375

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD BOONE BRACKETT III
Credential	:	M.D.
Telephone Number	:	708-848-7700

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/08/2008

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Directions to “WESTGATE ORTHOPAEDICS, LTD. ” Practice Location

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