Healthcare Provider Details

I. General information

NPI: 1477069607
Provider Name (Legal Business Name): GITELIS ORTHOPEDICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 12/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MCDONOUGH RD STE 202
HOFFMAN ESTATES IL
60192-4565
US

IV. Provider business mailing address

1800 MCDONOUGH RD STE 202
HOFFMAN ESTATES IL
60192-4565
US

V. Phone/Fax

Practice location:
  • Phone: 847-807-7770
  • Fax: 847-807-7771
Mailing address:
  • Phone: 847-807-7770
  • Fax: 847-807-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number036055465
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL GITELIS
Title or Position: AUTHORIZED OFFICIAL/PROVIDER
Credential: MD
Phone: 847-807-7770