Provider Demographics
NPI:1811942451
Name:MIDWEST ORTHOPAEDICS AT RUSH, LLC
Entity type:Organization
Organization Name:MIDWEST ORTHOPAEDICS AT RUSH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-236-2673
Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:#240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:708-236-2673
Mailing Address - Fax:708-409-5179
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:# 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-432-2300
Practice Address - Fax:708-409-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDA4902OtherRAILROAD MEDICARE NUMBER
ILDA5233OtherRAILROAD MEDICARE NUMBER
IL209118Medicare PIN
ILDA4902OtherRAILROAD MEDICARE NUMBER
209119Medicare PIN
IL207067Medicare PIN