Provider Demographics
NPI:1326223579
Name:JB ORTHOPEDIC CONSULTING, SC
Entity Type:Organization
Organization Name:JB ORTHOPEDIC CONSULTING, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BRNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-480-7580
Mailing Address - Street 1:1187 WILMETTE AVE
Mailing Address - Street 2:#213
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:666 DUNDEE RD
Practice Address - Street 2:SUITE 1001
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2727
Practice Address - Country:US
Practice Address - Phone:847-480-7580
Practice Address - Fax:847-227-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.619179036.064599261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC48334Medicare UPIN