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
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1790303725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS BONE AND JOINT INSTITUTE LLC

Provider Business Mailing Address
First Line	:	900 RAND RD STE 300
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-2359
Country	:	US
Telephone Number	:	847-324-3976
Fax Number	:	847-929-1154

Provider Business Practice Location Address
First Line	:	1009 IL ROUTE 22 STE 2
Second Line	:
City	:	FOX RIVER GROVE
State	:	IL
Zip	:	60021-1998
Country	:	US
Telephone Number	:	847-842-9366
Fax Number	:	847-842-9467

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WAYNE GOLDSTEIN
Credential	:
Telephone Number	:	847-324-3976

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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

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