Provider Demographics
NPI:1477898716
Name:CORE ORTHOPEDICS & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:CORE ORTHOPEDICS & SPORTS MEDICINE LLC
Other - Org Name:CORE IMAGING CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUESIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-690-1776
Mailing Address - Street 1:2380 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-2025
Mailing Address - Country:US
Mailing Address - Phone:847-690-1776
Mailing Address - Fax:847-690-1777
Practice Address - Street 1:2380 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-2025
Practice Address - Country:US
Practice Address - Phone:847-690-1776
Practice Address - Fax:847-690-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies