Provider Demographics
NPI:1407006075
Name:GREAT LAKES ORTHOPAEDICS, S.C.
Entity Type:Organization
Organization Name:GREAT LAKES ORTHOPAEDICS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-918-7648
Mailing Address - Street 1:270 E. CENTER DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1518
Mailing Address - Country:US
Mailing Address - Phone:847-573-1157
Mailing Address - Fax:847-918-7648
Practice Address - Street 1:270 E. CENTER DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1518
Practice Address - Country:US
Practice Address - Phone:847-573-1157
Practice Address - Fax:847-918-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073202207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty