Healthcare Provider Details

I. General information

NPI: 1710114418
Provider Name (Legal Business Name): MIDAMERICA ORTHOPAEDICS S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 S ROBERTS RD
PALOS HILLS IL
60465-1971
US

IV. Provider business mailing address

10330 S ROBERTS RD
PALOS HILLS IL
60465-1971
US

V. Phone/Fax

Practice location:
  • Phone: 708-237-7200
  • Fax: 708-237-7201
Mailing address:
  • Phone: 708-237-7200
  • Fax: 708-237-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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