Healthcare Provider Details

I. General information

NPI: 1912908757
Provider Name (Legal Business Name): ILLIANA ORTHOPEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17222 HARLEM AVE
TINLEY PARK IL
60477-3368
US

IV. Provider business mailing address

17222 HARLEM AVE
TINLEY PARK IL
60477-3368
US

V. Phone/Fax

Practice location:
  • Phone: 708-532-5600
  • Fax: 708-532-5611
Mailing address:
  • Phone: 708-532-5600
  • Fax: 708-532-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN F SEIBT
Title or Position: PRESIDENT
Credential: CP LPO
Phone: 708-532-5600