Healthcare Provider Details

I. General information

NPI: 1952614836
Provider Name (Legal Business Name): IBJI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S NORTHWEST HWY STE 200
PARK RIDGE IL
60068-4252
US

IV. Provider business mailing address

250 S NORTHWEST HWY STE 200
PARK RIDGE IL
60068-4252
US

V. Phone/Fax

Practice location:
  • Phone: 847-324-3976
  • Fax:
Mailing address:
  • Phone: 847-324-3976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: WAYNE GOLDSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 847-375-3000