1457535452 NPI number — ASSOCIATES IN ORTHOPAEDIC SURGERY

Table of content: (NPI 1457535452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457535452 NPI number — ASSOCIATES IN ORTHOPAEDIC SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN ORTHOPAEDIC SURGERY
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:
1457535452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 N RANDALL RD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60123-9400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-888-0750
Provider Business Mailing Address Fax Number:
847-888-2152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 N RT 31
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-455-0555
Provider Business Practice Location Address Fax Number:
815-459-4204
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DONNER
Authorized Official First Name:
CONSTANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
847-888-0750

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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