Healthcare Provider Details

I. General information

NPI: 1861796096
Provider Name (Legal Business Name): HINSDALE ORTHOPAEDIC ASSOCIATES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 ESSINGTON RD
JOLIET IL
60435-8427
US

IV. Provider business mailing address

951 ESSINGTON RD
JOLIET IL
60435-8427
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-4551
  • Fax: 815-744-4756
Mailing address:
  • Phone: 815-744-4551
  • Fax: 815-744-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number042620352
License Number StateIL

VIII. Authorized Official

Name: MICHAEL C DURKIN
Title or Position: MD
Credential: MD
Phone: 630-794-8671