Provider Demographics
NPI:1619640331
Name:GREYLEDGE ORTHOBIOLOGIC GROUP LLC
Entity Type:Organization
Organization Name:GREYLEDGE ORTHOBIOLOGIC GROUP LLC
Other - Org Name:MITCHELL B. SHEINKOP, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHEINKOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-475-1893
Mailing Address - Street 1:618 W FULTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1144
Mailing Address - Country:US
Mailing Address - Phone:312-475-1893
Mailing Address - Fax:312-910-2460
Practice Address - Street 1:618 W FULTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1144
Practice Address - Country:US
Practice Address - Phone:312-475-1893
Practice Address - Fax:312-910-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty