Healthcare Provider Details

I. General information

NPI: 1215133657
Provider Name (Legal Business Name): ORTHOPAEDIC AND SPINE SURGERY CENTER,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK RD SUITE 4290
ELMHURST IL
60126
US

IV. Provider business mailing address

3000 N HALSTED ST SUITE 611
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-3900
  • Fax: 773-296-3901
Mailing address:
  • Phone: 773-296-3900
  • Fax: 773-296-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIRIAM J GONZALES
Title or Position: OFFICE MANAGER
Credential:
Phone: 773-296-3900