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General NPI Number Information
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NPI Number | 1689151078
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Entity Type | Organization
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Legal Business Name | CHICAGO BONE AND JOINT INSTITUTE, LLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 8630 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60652-3633
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Country | US
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Telephone | 773-767-8133
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Fax |
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Provider Business Mailing Address
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Address Line | 8630 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60652-3633
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Country | US
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Telephone | 773-767-8133
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED MANAGER
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Name | MOHAMED SIRAJUDEEN
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Credential | MR
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Telephone | 773-552-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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