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General NPI Number Information
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NPI Number | 1578971487
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS TRAUMA REGIONAL ORTHOPAEDICS, LLC
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 1235 N MULFORD RD SUITE 103
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City | ROCKFORD
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State | IL
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Zip | 61107-3879
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Country | US
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Telephone | 815-636-0700
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Fax | 815-904-6033
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Provider Business Mailing Address
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Address Line | 1235 N MULFORD RD SUITE 103
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City | ROCKFORD
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State | IL
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Zip | 61107-3879
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Country | US
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Telephone | 815-636-0700
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Fax | 815-904-6033
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW J BLINT
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Credential | MD
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Telephone | 815-636-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number |
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License Number State |
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