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General NPI Number Information
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NPI Number | 1013976927
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Entity Type | Organization
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Legal Business Name | MIDWEST ORTHOPAEDIC INSTITUTE P C
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 2111 MIDLANDS COURT
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City | SYCAMORE
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State | IL
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Zip | 60178
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Country | US
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Telephone | 815-758-0000
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Fax | 815-758-0094
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Provider Business Mailing Address
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Address Line | 1952 ABERDEEN CT
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City | SYCAMORE
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State | IL
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Zip | 60178-3175
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Country | US
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Telephone | 815-758-0000
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Fax | 815-748-3014
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | ASHLEY ROSS
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Credential |
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Telephone | 815-991-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 060010536
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 060010536
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 060010536
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License Number State | IN
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Taxonomy #8
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 060010536
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License Number State | IL
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Taxonomy #9
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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