# ORTHOMIDWEST, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OrthoIllinois
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477049070
- **Authorized official:** LESLIE ELMER (MANAGER, CREDENTIALING AND RISK MAN)
- **Authorized official phone:** (815) 381-7431

## Contact information

- **Practice address:** 650 S RANDALL RD, ALGONQUIN, IL 60102-5944
- **Practice address phone:** (815) 398-9491
- **Mailing address:** PO BOX 735263, CHICAGO, IL 60673-5263
- **Mailing address phone:** (181) 538-1743

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 07/06/2018
- **Last updated:** 04/19/2024