Healthcare Provider Details

I. General information

NPI: 1114171477
Provider Name (Legal Business Name): CHICAGO ORTHOPAEDICS AND SPORTS MEDICINE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST #525
CHICAGO IL
60657-5188
US

IV. Provider business mailing address

3000 N HALSTED ST #525
CHICAGO IL
60657-5188
US

V. Phone/Fax

Practice location:
  • Phone: 773-433-3130
  • Fax: 773-433-3125
Mailing address:
  • Phone: 773-433-3130
  • Fax: 773-433-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-070934
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number036-070934
License Number StateIL

VIII. Authorized Official

Name: DAVID A HOFFMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 773-433-3130