Healthcare Provider Details

I. General information

NPI: 1194887166
Provider Name (Legal Business Name): GOLD COAST ORTHOPEDICS AND REHABILITATION, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 191ST ST
MOKENA IL
60448-9381
US

IV. Provider business mailing address

1443 N DEARBORN ST
CHICAGO IL
60610-1505
US

V. Phone/Fax

Practice location:
  • Phone: 708-719-3527
  • Fax:
Mailing address:
  • Phone: 708-719-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036052805
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB MORGENSTERN
Title or Position: OWNER
Credential: M.D.
Phone: 708-719-3527