Healthcare Provider Details

I. General information

NPI: 1790303725
Provider Name (Legal Business Name): ILLINOIS BONE AND JOINT INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 IL ROUTE 22 STE 2
FOX RIVER GROVE IL
60021-1998
US

IV. Provider business mailing address

900 RAND RD STE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 847-842-9366
  • Fax: 847-842-9467
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

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: WAYNE GOLDSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 847-324-3976