Provider Demographics
NPI:1821410929
Name:SUBURBAN ORTHOPAEDICS
Entity Type:Organization
Organization Name:SUBURBAN ORTHOPAEDICS
Other - Org Name:SUBURBAN ORTHOPAEDICS LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE & COMPLIANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-372-1100
Mailing Address - Street 1:1110 W SCHICK RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-3007
Mailing Address - Country:US
Mailing Address - Phone:630-233-7029
Mailing Address - Fax:
Practice Address - Street 1:1229 W RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1627
Practice Address - Country:US
Practice Address - Phone:630-233-7029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064932207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212203Medicare UPIN