1235298571 NPI number — ILLINOIS BONE AND JOINT INSTITUTE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235298571 NPI number — ILLINOIS BONE AND JOINT INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ILLINOIS BONE AND JOINT INSTITUTE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235298571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 RAND RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60016-2359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-324-3976
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 WAUKEGAN RD STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANNOCKBURN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-914-0544
Provider Business Practice Location Address Fax Number:
847-914-0547
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDSTEIN
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-324-3976

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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