MEDICARE: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1326258831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD.

Provider Business Mailing Address
First Line	:	4844 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0048
Country	:	US
Telephone Number	:	847-437-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E SCHAUMBURG ROAD
Second Line	:	SUITE 201
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-3548
Country	:	US
Telephone Number	:	847-437-9889
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROSEMARY A MARTIN
Credential	:
Telephone Number	:	847-437-9889

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	05/21/2008

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