Provider Demographics
NPI:1376515866
Name:ORTHOPEDIC ASSOCIATES OF CHICAGO
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF CHICAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PROCTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-943-7850
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:STE 450
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:STE 450
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-943-7850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE19073Medicare UPIN
ILF17825Medicare UPIN
ILD88652Medicare UPIN
ILC42487Medicare UPIN
ILD13082Medicare UPIN
ILE80572Medicare UPIN
ILH00217Medicare UPIN
ILE64550Medicare UPIN
ILH47815Medicare UPIN
ILD13896Medicare UPIN
ILG53311Medicare UPIN