Healthcare Provider Details

I. General information

NPI: 1285603928
Provider Name (Legal Business Name): CHICAGO ORTHOPAEDIC & SPORTS MEDICINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST SUITE 525
CHICAGO IL
60657
US

IV. Provider business mailing address

3000 N HALSTED ST #525
CHICAGO IL
60657-5188
US

V. Phone/Fax

Practice location:
  • Phone: 773-433-3130
  • Fax: 773-433-3125
Mailing address:
  • Phone: 773-433-3130
  • Fax: 773-433-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID GUELICH
Title or Position: PRESIDENT
Credential: MD
Phone: 773-433-3130