Provider Demographics
NPI:1093918161
Name:CORE ORTHOPEDICS & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:CORE ORTHOPEDICS & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KUESIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-690-1776
Mailing Address - Street 1:555 BIESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3306
Mailing Address - Country:US
Mailing Address - Phone:847-690-1776
Mailing Address - Fax:847-690-1777
Practice Address - Street 1:555 BIESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3306
Practice Address - Country:US
Practice Address - Phone:847-690-1776
Practice Address - Fax:847-690-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG8924OtherRR MEDICARE
5950670001Medicare NSC
DG8924OtherRR MEDICARE