Healthcare Provider Details

I. General information

NPI: 1104851823
Provider Name (Legal Business Name): CASTLE ORTHOPAEDICS & SPORTS MEDICINE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 OGDEN AVE
AURORA IL
60504
US

IV. Provider business mailing address

2111 OGDEN AVE
AURORA IL
60504
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-3800
  • Fax: 630-862-3086
Mailing address:
  • Phone: 630-978-3800
  • Fax: 630-862-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number042005445
License Number StateIL

VIII. Authorized Official

Name: KATIE WAEGNER
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 630-978-3800