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NPI Code Detail

MEDICARE: ELITE ORTHOPAEDICS AND SPORTS MEDICINE, LLC

MEDICARE: ELITE ORTHOPAEDICS AND SPORTS MEDICINE, LLC
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician036094752IL

General Provider Information

NPI Number : 1356780530
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Provider Business Mailing Address
First Line : 6524 W ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-2400
Country : US
Telephone Number : 773-229-1414
Fax Number :
Provider Business Practice Location Address
First Line : 2875 W 19TH ST
Second Line : 2ND FLOOR - PHYSICIAN CENTER (NORTH SUITE)
City : CHICAGO
State : IL
Zip : 60623-3501
Country : US
Telephone Number : 773-229-1414
Fax Number :
Authorized Official
Title or Position : PHYSICIAN / OWNER
Name : DR. CHANDRASEKHAR SOMPALLI
Credential : M.D.
Telephone Number : 773-229-1414
Provider Enumeration Date : 06/20/2013
Last Update Date : 03/23/2017

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Directions to “ELITE ORTHOPAEDICS AND SPORTS MEDICINE, LLC ” Practice Location

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