Healthcare Provider Details

I. General information

NPI: 1760626717
Provider Name (Legal Business Name): ANTHONY S RINELLA M D S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 W. 143RD STREET SUITE 110
HOMER GLEN IL
60491-7721
US

IV. Provider business mailing address

12701 W. 143RD STREET SUITE 110
HOMER GLEN IL
60491-7721
US

V. Phone/Fax

Practice location:
  • Phone: 877-694-7722
  • Fax: 815-531-0055
Mailing address:
  • Phone: 877-694-7722
  • Fax: 815-531-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036106352
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036106352
License Number StateIL

VIII. Authorized Official

Name: MS. WENDY BENDFELDT
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 877-694-7722