Provider Demographics
NPI:1235100066
Name:TREISTER ORTHOPAEDIC SERVICES LTD
Entity Type:Organization
Organization Name:TREISTER ORTHOPAEDIC SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:TREISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-633-5866
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1797
Mailing Address - Country:US
Mailing Address - Phone:312-633-5866
Mailing Address - Fax:
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1797
Practice Address - Country:US
Practice Address - Phone:312-633-5866
Practice Address - Fax:312-491-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36042189174400000X
IL36057244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615856OtherBCBS
IL1615856OtherBCBS