Provider Demographics
NPI:1558661272
Name:ORTHOPEDIC ASSOCIATES OF KANKAKEE
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF KANKAKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHMIELEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-928-8060
Mailing Address - Street 1:400 S KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915
Mailing Address - Country:US
Mailing Address - Phone:815-928-8060
Mailing Address - Fax:800-505-2218
Practice Address - Street 1:400 S KENNEDY DR
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2682
Practice Address - Country:US
Practice Address - Phone:815-928-8060
Practice Address - Fax:800-505-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty