Healthcare Provider Details

I. General information

NPI: 1700023793
Provider Name (Legal Business Name): PRIMUS ORTHOPEDICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7543 183RD ST
TINLEY PARK IL
60477-6208
US

IV. Provider business mailing address

7543 183RD ST
TINLEY PARK IL
60477-6208
US

V. Phone/Fax

Practice location:
  • Phone: 708-263-2000
  • Fax: 708-263-2023
Mailing address:
  • Phone: 708-263-2000
  • Fax: 708-263-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number036-118611
License Number StateIL

VIII. Authorized Official

Name: DR. GREGORY LAMAR PRIMUS
Title or Position: ORTHOPEDIC SURGEON
Credential: M.D.
Phone: 708-263-2000