Provider Demographics
NPI:1619004082
Name:CHICAGO ORTHOPAEDICS AND SPORTS MEDICINE SC
Entity Type:Organization
Organization Name:CHICAGO ORTHOPAEDICS AND SPORTS MEDICINE SC
Other - Org Name:LINCOLN PARK PHYSICAL THERAPY INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-716-0800
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:#525
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-328-5930
Mailing Address - Fax:773-433-3145
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:527
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-328-5930
Practice Address - Fax:773-433-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCC4422OtherRR MEDICARE
IL130813301OtherDOL
ILCC4422OtherRR MEDICARE
IL206304Medicare PIN