Provider Demographics
NPI:1043924376
Name:ORTHOMIDWEST, PLLC
Entity Type:Organization
Organization Name:ORTHOMIDWEST, PLLC
Other - Org Name:MIDWEST ORTHOPAEDICS AT RUSH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRINCIPAL PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-398-9491
Mailing Address - Street 1:PO BOX 735263
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5263
Mailing Address - Country:US
Mailing Address - Phone:877-632-6637
Mailing Address - Fax:
Practice Address - Street 1:9200 CALUMET AVE STE 300
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2885
Practice Address - Country:US
Practice Address - Phone:877-632-6637
Practice Address - Fax:708-409-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies