MEDICARE: GROSSKOPF ORTHOPEDIC SC

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	207X00000X	Orthopaedic Surgery Physician	036066604	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C44349	OTHER	IL	UPIN

General Provider Information

NPI Number	:	1255622163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROSSKOPF ORTHOPEDIC SC

Provider Business Mailing Address
First Line	:	3805 E MAIN ST
Second Line	:	SUITE G
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-2487
Country	:	US
Telephone Number	:	630-402-2128
Fax Number	:	630-397-7814

Provider Business Practice Location Address
First Line	:	3805 E MAIN ST
Second Line	:	SUITE G
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-2487
Country	:	US
Telephone Number	:	630-402-2128
Fax Number	:	630-397-7814

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JEFFREY W. GROSSKOPF
Credential	:	M.D.
Telephone Number	:	630-402-2128

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	04/10/2017

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Directions to “GROSSKOPF ORTHOPEDIC SC ” Practice Location

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