Provider Demographics
NPI:1205192978
Name:ILLINOIS ORTHOPEDIC NETWORK, LLC
Entity Type:Organization
Organization Name:ILLINOIS ORTHOPEDIC NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRONGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-451-4913
Mailing Address - Street 1:712 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3818
Mailing Address - Country:US
Mailing Address - Phone:312-451-4913
Mailing Address - Fax:312-268-5434
Practice Address - Street 1:712 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3818
Practice Address - Country:US
Practice Address - Phone:312-451-4913
Practice Address - Fax:312-268-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-07
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty