Healthcare Provider Details

I. General information

NPI: 1285084046
Provider Name (Legal Business Name): SOUTH CHICAGO ORTHOPEDIC SPECIALISTS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W MONTEREY AVE STE 4
CHICAGO IL
60643-4257
US

IV. Provider business mailing address

1701 W MONTEREY AVE STE 4
CHICAGO IL
60643-4257
US

V. Phone/Fax

Practice location:
  • Phone: 872-228-0235
  • Fax: 773-530-0520
Mailing address:
  • Phone: 872-228-0235
  • Fax: 773-530-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036118743
License Number StateIL

VIII. Authorized Official

Name: STEVEN ARTHUR CHANDLER
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 872-228-0235