Healthcare Provider Details

I. General information

NPI: 1366495186
Provider Name (Legal Business Name): HAND SURGERY, LTD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 319
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

541 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

V. Phone/Fax

Practice location:
  • Phone: 312-738-3426
  • Fax:
Mailing address:
  • Phone: 219-934-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SCHENCK
Title or Position: PRESIDENT
Credential: MD
Phone: 312-738-3426