Provider Demographics
NPI:1235637851
Name:SPECIALTY ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:SPECIALTY ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-743-1337
Mailing Address - Street 1:911 N ELM ST STE 327
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3642
Mailing Address - Country:US
Mailing Address - Phone:630-387-6589
Mailing Address - Fax:630-387-9789
Practice Address - Street 1:911 N ELM ST STE 327
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3642
Practice Address - Country:US
Practice Address - Phone:630-387-6589
Practice Address - Fax:630-387-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
036118586207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty