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General NPI Number Information
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NPI Number | 1306504071
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Entity Type | Organization
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Legal Business Name | ORTHOMIDWEST, PLLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 150 S EASTWOOD DR
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City | WOODSTOCK
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State | IL
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Zip | 60098
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Country | US
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Telephone | 815-381-7431
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735263
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City | CHICAGO
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State | IL
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Zip | 60673-5263
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Country | US
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Telephone | 815-381-7431
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING AND RISK MANAGER
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Name | LESLIE ELMER
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Credential |
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Telephone | 815-381-7431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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