Basic Information
| Provider Information | |||||||||
| NPI: | 1629083076 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BONE & JOINT SPECIALISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9001 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464107039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197953360 | ||||||||
| FaxNumber: | 2197566500 | ||||||||
| Practice Location | |||||||||
| Address1: | 9001 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464107039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197953360 | ||||||||
| FaxNumber: | 2197566500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | HAM | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2197953360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00276218 | 01 | IN | RAILROAD MEDICARE | OTHER | 5426631 | 01 | IN | AETNA - KENNETH J. HAM, MD | OTHER | 611265200 | 01 | IN | DEPARTMENT OF LABOR | OTHER | 200536660 | 05 | IN | MEDICAID | 000000383653 | 01 | IN | ANTHEM BCBS | OTHER | 4611377 | 01 | IN | AETNA - JOSEPH F. SCHWARTZ, MD | OTHER | 90001242 | 01 | IN | BCBS OF ILLINOIS | OTHER |