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Organization
ORTHOPAEDIC CENTER OF ILLINOIS
Active
Organization
ORTHOPAEDIC CENTER OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA SMITH (EXECUTIVE ADMINISTRATIVE ASSISTANT)
(217) 547-9100
Entity
Organization
Contact information
Practice address
1301 S KOKE MILL RD, SPRINGFIELD, IL 62711-9252
(217) 547-9100
(217) 547-9236
Mailing address
1301 S KOKE MILL RD, SPRINGFIELD, IL 62711-9252
(217) 547-9100
(217) 547-9236
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
042007969
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
042007969
IL
Other
Enumeration date
11/05/2014
Last updated
11/06/2020
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