Provider Demographics
NPI:1083817407
Name:CENTER FOR ATHLETIC MEDICINE LTD
Entity Type:Organization
Organization Name:CENTER FOR ATHLETIC MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-248-4150
Mailing Address - Street 1:830 W DIVERSEY PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1454
Mailing Address - Country:US
Mailing Address - Phone:773-248-4150
Mailing Address - Fax:773-248-4291
Practice Address - Street 1:830 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1454
Practice Address - Country:US
Practice Address - Phone:773-248-4150
Practice Address - Fax:773-248-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36060229207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL323830Medicare PIN
ILB99041Medicare UPIN