Provider Demographics
NPI:1952573149
Name:BROADWAY ORTHOPEDICS LTD
Entity Type:Organization
Organization Name:BROADWAY ORTHOPEDICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKKERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-344-0870
Mailing Address - Street 1:1111SUPERIOR STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4158
Mailing Address - Country:US
Mailing Address - Phone:708-344-0870
Mailing Address - Fax:708-343-4490
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-344-0870
Practice Address - Fax:708-343-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21604940OtherBLUE CROSS BLUE SHIELD
IL036042498Medicaid
1306880919OtherPROVIDER NPI
C42021Medicare UPIN
IL036042498Medicaid