Healthcare Provider Details

I. General information

NPI: 1609935949
Provider Name (Legal Business Name): ILLINOIS BONE AND JOINT INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E CENTRAL RD
ARLINGTON HEIGHTS IL
60005-2857
US

IV. Provider business mailing address

5057 PAYSPHERE CIR
CHICAGO IL
60674-0050
US

V. Phone/Fax

Practice location:
  • Phone: 847-870-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WAYNE M GOLDSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 847-324-3976