MEDICARE: ALTON ORTHOPEDIC CLINIC, 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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1770582157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTON ORTHOPEDIC CLINIC, LTD

Provider Business Mailing Address
First Line	:	2710 COLLEGE AVE
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-4707
Country	:	US
Telephone Number	:	618-462-1201
Fax Number	:	618-462-0744

Provider Business Practice Location Address
First Line	:	2710 COLLEGE AVE
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-4707
Country	:	US
Telephone Number	:	618-462-1201
Fax Number	:	618-462-0744

Authorized Official
Title or Position	:	PRESIDENT-ALTON ORTHOPEDIC CLINIC
Name	:	DR. MICHAEL M TAYLOR
Credential	:	M.D.
Telephone Number	:	618-462-1201

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/22/2020

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