# GENESIS ORTHOPEDICS & SPORTS MEDICINE LLC

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

## Provider details

- **NPI number:** 1346389061
- **Authorized official:** DR. HYTHEM P SHADID MD (OWNER)
- **Authorized official phone:** (630) 377-1188

## Contact information

- **Practice address:** 2900 FOXFIELD RD, SUITE 102, ST CHARLES, IL 60174-5799
- **Practice address phone:** (630) 377-1188
- **Practice address fax:** (630) 377-7360
- **Mailing address:** 2900 FOXFIELD RD, SUITE 102, ST CHARLES, IL 60174-5799
- **Mailing address phone:** (630) 377-1188
- **Mailing address fax:** (630) 377-7360

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036082388 | IL | Yes |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 11/17/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036082388 | — | IL |
| 01 | — | 04525539 | BCBS | IL |
| 01 | — | 1205885001 | LESNIEWSKI NPI | IL |
| 01 | — | 1477567394 | SHADID NPI | IL |
| 01 | — | DO4326 | GROUP PTAN | IL |