Provider Demographics
NPI:1790942894
Name:ORTHOPAEDIC SURGERY SPECIALISTS LTD
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGERY SPECIALISTS LTD
Other - Org Name:PHYSICAL THERAPY INSTITUTE OF ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HO MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-824-3198
Mailing Address - Street 1:1550 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1411
Mailing Address - Country:US
Mailing Address - Phone:847-298-7024
Mailing Address - Fax:847-298-7155
Practice Address - Street 1:1009 IL ROUTE 22
Practice Address - Street 2:SUITE 2
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1998
Practice Address - Country:US
Practice Address - Phone:847-842-9366
Practice Address - Fax:847-842-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-18
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1224510002OtherMEDICARE DME SUPPLIER