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Organization
ORTHOPEDIC SPECIALISTS SC
Active
Organization
ORTHOPEDIC SPECIALISTS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY PANCAMO (BILLING SUPERVISOR)
(630) 333-4447
Entity
Organization
Contact information
Practice address
675 W NORTH AVE, SUITE314, MELROSE PARK, IL 60160-1634
(630) 782-9600
(630) 782-1643
Mailing address
360 W BUTTERFIELD ROAD, SUITE160, ELMHURST, IL 60126
(630) 782-9600
(630) 782-1643
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
016005007
IL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02222323
BCBS
IL
Enumeration date
11/21/2006
Last updated
02/10/2010
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