Provider Demographics
NPI:1720191091
Name:ORTHOPEDIC ASSOCIATES OF KANKAKEE SC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF KANKAKEE SC
Other - Org Name:ORTHOPEDIC ASSOCIATES OF KANKAKEE SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD PRESIDENT AND PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-928-8050
Mailing Address - Street 1:400 S KENNEDY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2685
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:SUITE 100
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2685
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:2006-08-17
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051481Medicaid
D13923Medicare UPIN
IL0284070001Medicare NSC
IL036051481Medicaid
IL738721Medicare PIN