Healthcare Provider Details

I. General information

NPI: 1356330286
Provider Name (Legal Business Name): BRUCE R DOLITSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 S 80TH AVE
PALOS HEIGHTS IL
60463-1270
US

IV. Provider business mailing address

12251 S 80TH AVE STE 1630
PALOS HEIGHTS IL
60463-1256
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4400
  • Fax: 708-923-4421
Mailing address:
  • Phone: 708-923-4400
  • Fax: 708-923-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036065042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: