# ORTHO SPINE SURGICAL LLC

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

## Provider details

- **NPI number:** 1386258226
- **Authorized official:** MR. MOHAMED S SIRAJUDEEN (PRESIDENT)
- **Authorized official phone:** (773) 761-0500

## Contact information

- **Practice address:** 1925 E 95TH ST STE 220, CHICAGO, IL 60617-4710
- **Practice address phone:** (773) 761-0500
- **Practice address fax:** (773) 761-1355
- **Mailing address:** 1925 E 95TH ST STE 220, CHICAGO, IL 60617-4710
- **Mailing address phone:** (773) 761-0500
- **Mailing address fax:** (773) 761-1355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/08/2020
- **Last updated:** 09/08/2020