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NPI Code Detail

MEDICARE: ILLINOIS BONE AND JOINT INSTITUTE,LLC

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 License Number License Number State
1207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1558420802
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 : 47 W POLK ST
Second Line : STE G1
City : CHICAGO
State : IL
Zip : 60605-2000
Country : US
Telephone Number : 312-444-1145
Fax Number :
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 : 08/12/2011

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Directions to “ILLINOIS BONE AND JOINT INSTITUTE,LLC ” Practice Location

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