Provider Demographics
NPI:1669776209
Name:HINSDALE ORTHOPAEDIC ASSOCIATES, SC
Entity type:Organization
Organization Name:HINSDALE ORTHOPAEDIC ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-794-8671
Mailing Address - Street 1:1010 EXECUTIVE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6135
Mailing Address - Country:US
Mailing Address - Phone:630-323-6116
Mailing Address - Fax:630-323-5610
Practice Address - Street 1:1010 EXECUTIVE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6135
Practice Address - Country:US
Practice Address - Phone:630-323-6116
Practice Address - Fax:630-323-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL042620512207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0662990002Medicare NSC
IL700860Medicare PIN