Healthcare Provider Details

I. General information

NPI: 1871652149
Provider Name (Legal Business Name): ILLINOIS BONE AND JOINT INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RAVINE WAY STE 100
GLENVIEW IL
60025-7645
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 847-724-4791
  • Fax:
Mailing address:
  • Phone: 847-324-3976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

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