Basic Information
| Provider Information | |||||||||
| NPI: | 1154350353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKVIEW ORTHOPAEDIC GROUP S C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 W COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083610600 | ||||||||
| FaxNumber: | 7089232529 | ||||||||
| Practice Location | |||||||||
| Address1: | 7600 W COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083610600 | ||||||||
| FaxNumber: | 7089232529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 10/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | JOSEK | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7089232510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | 036095475 | IL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 174400000X | 42000080 | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 605460 | 01 | IL | PROVIDER NUMBER | OTHER |