Provider Demographics
NPI:1811371990
Name:ORTHOPAEDICS & RHEUMATOLOGY OF THE NORTH SHORE
Entity Type:Organization
Organization Name:ORTHOPAEDICS & RHEUMATOLOGY OF THE NORTH SHORE
Other - Org Name:ORTHOPAEDICS OF THE NORTH SHORE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKAREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-869-7233
Mailing Address - Street 1:4709 GOLF RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:847-869-7233
Mailing Address - Fax:847-869-9461
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1231
Practice Address - Country:US
Practice Address - Phone:847-869-7233
Practice Address - Fax:847-869-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1619032109261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036040690Medicaid
IL036104339Medicaid
IL036043731Medicaid
IL036099046Medicaid
ILK35274Medicare PIN
IL036099046Medicaid
IL036104339Medicaid
IL036040690Medicaid
ILK34096Medicare PIN
ILC41590Medicare UPIN
IL036043731Medicaid
ILF400100593Medicare PIN