Healthcare Provider Details

I. General information

NPI: 1699030171
Provider Name (Legal Business Name): MIDAMERICA ORTHOPAEDICS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRANSAM PLAZA DR SUITE 460
OAKBROOK TERRACE IL
60181-4822
US

IV. Provider business mailing address

1 TRANSAM PLAZA DR SUITE 460
OAKBROOK TERRACE IL
60181-4822
US

V. Phone/Fax

Practice location:
  • Phone: 630-317-7007
  • Fax: 630-317-7088
Mailing address:
  • Phone: 630-317-7007
  • Fax: 630-317-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-076397
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036-076397
License Number StateIL

VIII. Authorized Official

Name: DR. ANTON J FAKHOURI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-237-7200