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NPI Code Detail

MEDICARE: DEREK J ORTON MD

MEDICARE: DEREK J ORTON MD
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) Physician49025WI
2207X00000XOrthopaedic Surgery Physician49025WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01114676OTHERWIRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790742724
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK J ORTON MD
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 9000 W SURA LN
Second Line :
City : GREENFIELD
State : WI
Zip : 53228-3477
Country : US
Telephone Number : 262-329-2225
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 04/01/2024

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