Basic Information
| Provider Information | |||||||||
| NPI: | 1821401316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPEDIC SPECIALISTS, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 W BUTTERFIELD RD | ||||||||
| Address2: | #160 | ||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601265068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307829600 | ||||||||
| FaxNumber: | 6307821643 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 W BUTTERFIELD RD | ||||||||
| Address2: | #160 | ||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601265068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307829600 | ||||||||
| FaxNumber: | 6307821643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2014 | ||||||||
| LastUpdateDate: | 06/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | HENNESSEY | ||||||||
| AuthorizedOfficialFirstName: | RYON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6307829600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 085005057 | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.