Healthcare Provider Details

I. General information

NPI: 1841209459
Provider Name (Legal Business Name): ERIC THOMAS ORTINAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W US ROUTE 6 SUITE 100
MORRIS IL
60450-3349
US

IV. Provider business mailing address

1051 W US ROUTE 6 SUITE 100
MORRIS IL
60450-3349
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-4875
  • Fax: 915-942-5046
Mailing address:
  • Phone: 815-942-4875
  • Fax: 915-942-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036087313
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: