Healthcare Provider Details

I. General information

NPI: 1811942451
Provider Name (Legal Business Name): MIDWEST ORTHOPAEDICS AT RUSH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST # 400
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1 WESTBROOK CORPORATE CTR #240
WESTCHESTER IL
60154-5701
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2300
  • Fax: 708-409-5179
Mailing address:
  • Phone: 708-236-2673
  • Fax: 708-409-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN J. COLE
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 708-236-2673