Provider Demographics
NPI:1073700449
Name:MIDWEST BONE & JOINT SURGERY PC
Entity Type:Organization
Organization Name:MIDWEST BONE & JOINT SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:F
Authorized Official - Last Name:UNGACTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-541-1406
Mailing Address - Street 1:30 APEX DRIVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1285
Mailing Address - Country:US
Mailing Address - Phone:618-654-5400
Mailing Address - Fax:618-654-8700
Practice Address - Street 1:30 APEX DRIVE
Practice Address - Street 2:SUITE #1
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1285
Practice Address - Country:US
Practice Address - Phone:618-654-5400
Practice Address - Fax:618-654-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215632OtherMEDICARE GROUP PROVIDER #
ILK45126OtherMEDICARE INDIVIDUAL PVDR#
IL215632OtherMEDICARE GROUP PROVIDER #