Provider Demographics
NPI:1598800997
Name:MIDWEST ORTHOPAEDIC NETWORK, LLC
Entity Type:Organization
Organization Name:MIDWEST ORTHOPAEDIC NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-798-7673
Mailing Address - Street 1:111 N CANAL ST
Mailing Address - Street 2:SUITE 915
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-7206
Mailing Address - Country:US
Mailing Address - Phone:312-906-9900
Mailing Address - Fax:312-906-9471
Practice Address - Street 1:111 N CANAL ST
Practice Address - Street 2:SUITE 915
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-7206
Practice Address - Country:US
Practice Address - Phone:312-906-9900
Practice Address - Fax:312-906-9471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty