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General NPI Number Information
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NPI Number | 1346389061
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Entity Type | Organization
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Legal Business Name | GENESIS ORTHOPEDICS & SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 2900 FOXFIELD RD SUITE 102
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City | ST CHARLES
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State | IL
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Zip | 60174-5799
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Country | US
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Telephone | 630-377-1188
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Fax | 630-377-7360
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Provider Business Mailing Address
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Address Line | 2900 FOXFIELD RD SUITE 102
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City | ST CHARLES
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State | IL
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Zip | 60174-5799
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Country | US
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Telephone | 630-377-1188
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Fax | 630-377-7360
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Authorized Official
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Title or Position | OWNER
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Name | DR. HYTHEM P SHADID
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Credential | MD
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Telephone | 630-377-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036082388
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License Number State | IL
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