Provider Demographics
NPI:1669400271
Name:UPTOWN ORTHOPAEDIC SURGEONS SC
Entity type:Organization
Organization Name:UPTOWN ORTHOPAEDIC SURGEONS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-275-5177
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE # 6116-18
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-275-5176
Mailing Address - Fax:773-275-1130
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE # 6116-18
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-275-5176
Practice Address - Fax:773-275-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-048615174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12940Medicare UPIN
IL595280/L81406Medicare ID - Type Unspecified
IL595290/L81410Medicare ID - Type Unspecified
ILD13556Medicare UPIN
IL595280/L81409Medicare ID - Type Unspecified
ILD89449Medicare UPIN
IL595280/L81400Medicare ID - Type Unspecified