Provider Demographics
NPI:1043612427
Name:MALDONADO & O'CONNELL
Entity Type:Organization
Organization Name:MALDONADO & O'CONNELL
Other - Org Name:ELITE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-328-9220
Mailing Address - Street 1:1921 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1603
Mailing Address - Country:US
Mailing Address - Phone:312-328-9220
Mailing Address - Fax:312-328-9970
Practice Address - Street 1:1921 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1603
Practice Address - Country:US
Practice Address - Phone:312-328-9220
Practice Address - Fax:312-328-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021030261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy