=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477069607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GITELIS ORTHOPEDICS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2017
-----------------------------------------------------
Last Update Date | 12/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 MCDONOUGH RD STE 202
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60192-4565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-807-7770
-----------------------------------------------------
Fax | 847-807-7771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 MCDONOUGH RD STE 202
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60192-4565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-807-7770
-----------------------------------------------------
Fax | 847-807-7771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL/PROVIDER
-----------------------------------------------------
Name | DR. MICHAEL GITELIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 847-807-7770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 036055465
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------