Healthcare Provider Details

I. General information

NPI: 1215938170
Provider Name (Legal Business Name): WHEATON ORTHOPAEDICS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 GUNDERSEN DR STE A
CAROL STREAM IL
60188-2402
US

IV. Provider business mailing address

327 GUNDERSEN DR STE A
CAROL STREAM IL
60188-2402
US

V. Phone/Fax

Practice location:
  • Phone: 630-665-9155
  • Fax: 630-665-5557
Mailing address:
  • Phone: 630-665-9155
  • Fax: 630-665-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number42001705
License Number StateIL

VIII. Authorized Official

Name: MRS. MAMIE T. MARTIN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 630-665-9155