Provider Demographics
NPI:1952469454
Name:ORTHOPAEDIC ASSOCIATES OF RIVERSIDE, PLLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF RIVERSIDE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SLECHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-442-0221
Mailing Address - Street 1:353 E BURLINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2189
Mailing Address - Country:US
Mailing Address - Phone:708-442-0221
Mailing Address - Fax:708-442-5670
Practice Address - Street 1:353 E BURLINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2189
Practice Address - Country:US
Practice Address - Phone:708-442-0221
Practice Address - Fax:708-442-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206750Medicare ID - Type Unspecified