Provider Demographics
NPI:1548387244
Name:MALDONADO O'CONNELL LTD.
Entity Type:Organization
Organization Name:MALDONADO O'CONNELL LTD.
Other - Org Name:ELITE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-360-0702
Mailing Address - Street 1:1455 S MICHIGAN AVE
Mailing Address - Street 2:STE. 230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2771
Mailing Address - Country:US
Mailing Address - Phone:312-360-0702
Mailing Address - Fax:312-360-0705
Practice Address - Street 1:1455 S MICHIGAN AVE
Practice Address - Street 2:STE. 230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2771
Practice Address - Country:US
Practice Address - Phone:312-360-0702
Practice Address - Fax:312-360-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633141OtherBLUE CROSS BLUE SHIELD
IL205449Medicare ID - Type Unspecified