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General NPI Number Information
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NPI Number | 1972264901
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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 | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 10110 DON S POWERS DR STE 101B
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City | MUNSTER
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State | IN
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Zip | 46321-4070
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Country | US
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Telephone | 219-961-9480
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Fax | 219-961-9556
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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 |
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Telephone | 847-324-3976
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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 |
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License Number State |
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