Provider Demographics
NPI:1194040808
Name:SUBURBAN ORTHOPAEDICS
Entity Type:Organization
Organization Name:SUBURBAN ORTHOPAEDICS
Other - Org Name:SUBURBAN ORTHOPAEDICS LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE & COMPLIANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-372-1100
Mailing Address - Street 1:1110 W SCHICK RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-3007
Mailing Address - Country:US
Mailing Address - Phone:630-372-1100
Mailing Address - Fax:630-372-6230
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:STE 565
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-439-9488
Practice Address - Fax:847-439-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007742111N00000X
IL036064932207X00000X
IL036097451207XS0117X
IL070012618208100000X
IL085001660363A00000X
IL085002852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064932Medicaid
IL01626816OtherBCBS
ILC43999Medicare UPIN
IL036064932Medicaid
212204Medicare PIN