Healthcare Provider Details

I. General information

NPI: 1013057397
Provider Name (Legal Business Name): ORTHOPEDIC & SPINE SURGERY ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2971 W ALGONQUIN RD #101B
ALGONQUIN IL
60102-9406
US

IV. Provider business mailing address

2350 ROYAL BLVD SUITE 200
ELGIN IL
60123-4719
US

V. Phone/Fax

Practice location:
  • Phone: 847-854-8840
  • Fax: 847-854-8851
Mailing address:
  • Phone: 847-931-5300
  • Fax: 847-931-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. SUSAN RYAN
Title or Position: MANAGER
Credential:
Phone: 847-931-5300