1699160010 NPI number — DR. TIMOTHY SEAN LEROUX MD, MED

Table of content: DR. TIMOTHY SEAN LEROUX MD, MED (NPI 1699160010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699160010 NPI number — DR. TIMOTHY SEAN LEROUX MD, MED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEROUX
Provider First Name:
TIMOTHY
Provider Middle Name:
SEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MED
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699160010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WESTBROOK CORPORATE CENTER, STE 240
Provider Second Line Business Mailing Address:
MIDWEST ORTHOPAEDICS AT RUSH, LLC
Provider Business Mailing Address City Name:
WESTCHESTER
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-236-2673
Provider Business Mailing Address Fax Number:
708-409-5179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 W. HARRISON ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-432-2300
Provider Business Practice Location Address Fax Number:
708-409-5179
Provider Enumeration Date:
04/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  036.137004 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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