Healthcare Provider Details

I. General information

NPI: 1245230747
Provider Name (Legal Business Name): MARIAN ORTHOPEDIC & REHABILITATION CENTERS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 W FULLERTON AVE
CHICAGO IL
60639-2503
US

IV. Provider business mailing address

39654 TREASURY CTR
CHICAGO IL
60694-9000
US

V. Phone/Fax

Practice location:
  • Phone: 312-326-6100
  • Fax: 773-725-0097
Mailing address:
  • Phone: 312-326-6100
  • Fax: 773-725-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036061666
License Number StateIL

VIII. Authorized Official

Name: DR. JOHN J O'KEEFE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-326-6100