MEDICARE: ILLINOIS BONE AND JOINT INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RR0500X	Rheumatology Physician
2	207RS0010X	Sports Medicine (Internal Medicine) Physician
3	213E00000X	Podiatrist
4	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1053470328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS BONE AND JOINT INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	5057 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 RAVINE WAY
Second Line	:	STE 600
City	:	GLENVIEW
State	:	IL
Zip	:	60025-7621
Country	:	US
Telephone Number	:	847-998-5680
Fax Number	:	847-998-6365

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WAYNE M GOLDSTEIN
Credential	:	MD
Telephone Number	:	847-324-3976

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/21/2017

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