MEDICARE: ADULT & PEDIATRIC ORTHOPEDICS, S.C.

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	042005991	IL

General Provider Information

NPI Number	:	1316069651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT & PEDIATRIC ORTHOPEDICS, S.C.

Provider Business Mailing Address
First Line	:	50 S MILWAUKEE AVE STE 201
Second Line	:
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-5426
Country	:	US
Telephone Number	:	224-372-7880
Fax Number	:	224-372-7870

Provider Business Practice Location Address
First Line	:	50 S MILWAUKEE AVE
Second Line	:	STE 201
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-9471
Country	:	US
Telephone Number	:	224-372-7880
Fax Number	:	224-372-7870

Authorized Official
Title or Position	:	BUSINESS OFFICE ADMINISTRATOR
Name	:	MISS JOANNE DEGENNARO
Credential	:
Telephone Number	:	847-634-0400

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	11/05/2014

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