Healthcare Provider Details

I. General information

NPI: 1750849428
Provider Name (Legal Business Name): OVATION HAND INSTITUTE-ILLINOIS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE STE 2200
CHICAGO IL
60611-6750
US

IV. Provider business mailing address

10532 N PORT WASHINGTON RD STE 1A
MEQUON WI
53092-5563
US

V. Phone/Fax

Practice location:
  • Phone: 844-432-1600
  • Fax: 920-915-9210
Mailing address:
  • Phone: 844-432-1600
  • Fax: 262-302-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TARRAH O'DONNELL
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 844-432-1600