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General NPI Number Information
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NPI Number | 1932625696
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Entity Type | Organization
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Legal Business Name | ILLINOIS BONE AND JOINT INSTITUTE, LLC
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 101 WAUKEGAN RD STE 1100
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City | LAKE BLUFF
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State | IL
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Zip | 60044-3012
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Country | US
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Telephone | 847-247-2402
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Fax | 847-247-2405
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Provider Business Mailing Address
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Address Line | 900 RAND RD STE 300
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City | DES PLAINES
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State | IL
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Zip | 60016-2359
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Country | US
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Telephone | 847-324-3976
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Fax | 847-929-1154
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Authorized Official
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Title or Position | PRESIDENT
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Name | WAYNE GOLDSTEIN
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Credential | MD
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Telephone | 847-375-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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