Provider Demographics
NPI:1740741461
Name:MOR PHYSICIAN NETWORK LLC
Entity Type:Organization
Organization Name:MOR PHYSICIAN NETWORK LLC
Other - Org Name:MOR PHYSICIAN NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-236-2737
Mailing Address - Street 1:1 WESTBROOK CORPORATE CENTER STE. 240
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154
Mailing Address - Country:US
Mailing Address - Phone:708-236-2737
Mailing Address - Fax:
Practice Address - Street 1:9200 CALUMET AVE STE 300
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2885
Practice Address - Country:US
Practice Address - Phone:708-236-2737
Practice Address - Fax:708-409-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty