# CHITOWN ORTHOPAEDICS & SPORTS MEDICINE S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174068944
- **Authorized official:** DR. EDWARD FORMAN D.O. (PRESIDENT)
- **Authorized official phone:** (773) 829-4700

## Contact information

- **Practice address:** 4801 W PETERSON AVE STE 606, CHICAGO, IL 60646-5728
- **Practice address phone:** (773) 829-4700
- **Practice address fax:** (773) 437-8446
- **Mailing address:** PO BOX 8497, NORTHFIELD, IL 60093-8497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036095583 | IL | Yes |

## Other

- **Enumeration date:** 01/03/2017
- **Last updated:** 02/19/2020