Provider Demographics
NPI:1821401316
Name:ORTHOPEDIC SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-782-9600
Mailing Address - Street 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:#160
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5068
Mailing Address - Country:US
Mailing Address - Phone:630-782-9600
Mailing Address - Fax:630-782-1643
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:#160
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:630-782-9600
Practice Address - Fax:630-782-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005057363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty