Provider Demographics
NPI:1881756302
Name:THE CENTER FOR SPORTS ORTHOPAEDICS S.C.
Entity type:Organization
Organization Name:THE CENTER FOR SPORTS ORTHOPAEDICS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-884-7771
Mailing Address - Street 1:1585 BARRINGTON RD
Mailing Address - Street 2:101
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5019
Mailing Address - Country:US
Mailing Address - Phone:847-884-7771
Mailing Address - Fax:847-884-0666
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:101
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1090
Practice Address - Country:US
Practice Address - Phone:847-884-7771
Practice Address - Fax:847-884-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42006967207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618989OtherBCBS OF ILLINOIS
ILCL6988OtherMEDICARE RR
IL972040Medicare PIN