Provider Demographics
NPI:1043415284
Name:NORTH CHICAGO ORTHOPAEDIC CLINIC
Entity Type:Organization
Organization Name:NORTH CHICAGO ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOUSHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAHVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-486-7200
Mailing Address - Street 1:PO BOX 7418
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-7418
Mailing Address - Country:US
Mailing Address - Phone:773-486-7200
Mailing Address - Fax:773-486-7667
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 235
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-486-7200
Practice Address - Fax:773-486-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053620Medicaid
200001533OtherRAILROAD MEDICARE
IL487660Medicare PIN