Healthcare Provider Details

I. General information

NPI: 1699100503
Provider Name (Legal Business Name): CASTLE ORTHOPAEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 OGDEN AVE
AURORA IL
60504-7597
US

IV. Provider business mailing address

2111 OGDEN AVE
AURORA IL
60504-7597
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-3800
  • Fax: 630-682-3085
Mailing address:
  • Phone: 630-978-3800
  • Fax: 630-682-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number041.139345
License Number StateIL

VIII. Authorized Official

Name: MS. LINDA J WALTER
Title or Position: NURSE
Credential: RN
Phone: 630-978-3800