MEDICARE: ORTHOPEDIC ASSOCIATES OF NORTHERN ILLINOIS, 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
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1740277102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC ASSOCIATES OF NORTHERN ILLINOIS, LLC

Provider Business Mailing Address
First Line	:	1235 N MULFORD RD
Second Line	:	SUITE 100
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3879
Country	:	US
Telephone Number	:	815-484-9999
Fax Number	:	815-484-4255

Provider Business Practice Location Address
First Line	:	1235 N MULFORD RD
Second Line	:	SUITE 100
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3879
Country	:	US
Telephone Number	:	815-484-9999
Fax Number	:	815-484-4255

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. DONNA PALMER-BEARD
Credential	:	CPA
Telephone Number	:	815-484-9999

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	12/13/2011

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