Provider Demographics
NPI:1356451355
Name:CHICAGO ORTHOPAEDIC & SPORTS MEDICINE SC
Entity Type:Organization
Organization Name:CHICAGO ORTHOPAEDIC & SPORTS MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUELICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-880-0400
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:525
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-880-0400
Mailing Address - Fax:773-880-0066
Practice Address - Street 1:2845 N SHERIDAN RD
Practice Address - Street 2:SUITE 6400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5194
Practice Address - Country:US
Practice Address - Phone:773-665-8400
Practice Address - Fax:773-665-8716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
130813301OtherDEPT OF LABOR
ILCC4422OtherRR MEDICARE
IL206304Medicare PIN
IL206304Medicare ID - Type Unspecified
IL0765120002Medicare NSC
ILCC4422OtherRR MEDICARE