1538675715 NPI number — GITELIS ORTHOPEDICS LTD

Table of content: (NPI 1538675715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538675715 NPI number — GITELIS ORTHOPEDICS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GITELIS ORTHOPEDICS LTD
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:
1538675715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 MCDONOUGH RD STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60192-4565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-807-7770
Provider Business Mailing Address Fax Number:
847-807-7771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 MCDONOUGH RD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60192-4565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-807-7770
Provider Business Practice Location Address Fax Number:
847-807-7771
Provider Enumeration Date:
12/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GITELIS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/PROVIDER
Authorized Official Telephone Number:
847-807-7770

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  036055465 , 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)

  • Identifier: 4028613 . This is a "AETNA INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 193531 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 180709 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5369851 . This is a "CIGNA INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 176690556237 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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