MEDICARE: ORTHOPEDIC, SPORTS & REHABILITATION CENTER, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician		IL
2	207X00000X	Orthopaedic Surgery Physician		IL

General Provider Information

NPI Number	:	1023218260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC, SPORTS & REHABILITATION CENTER, LTD.

Provider Business Mailing Address
First Line	:	6957 OLDE CREEK RD
Second Line	:	SUITE #3400
City	:	ROCKFORD
State	:	IL
Zip	:	61114-7416
Country	:	US
Telephone Number	:	815-397-6276
Fax Number	:	815-397-2266

Provider Business Practice Location Address
First Line	:	6957 OLDE CREEK RD
Second Line	:	SUITE #3400
City	:	ROCKFORD
State	:	IL
Zip	:	61114-7416
Country	:	US
Telephone Number	:	815-397-6276
Fax Number	:	815-397-2266

Authorized Official
Title or Position	:	OWNER
Name	:	TARA NIGAM
Credential	:	M.D.
Telephone Number	:	815-397-6276

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	02/15/2008

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