# MIDAMERICA ORTHOPAEDICS, S.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MidAmerica Hand to Shoulder Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700140613
- **Authorized official:** DR. ANTON J FAKHOURI M.D. (PRESIDENT)
- **Authorized official phone:** (708) 237-7200

## Contact information

- **Practice address:** 19065 HICKORY CREEK DR, SUITE 210, MOKENA, IL 60448-8507
- **Practice address phone:** (708) 237-7200
- **Practice address fax:** (815) 838-0590
- **Mailing address:** 19065 HICKORY CREEK DR, SUITE 210, MOKENA, IL 60448-8507
- **Mailing address phone:** (708) 237-7200
- **Mailing address fax:** (815) 838-0590

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036-084909 | IL | Yes |
| 2082S0105X | Surgery of the Hand (Plastic Surgery) Physician | 036-095853 | IL | — |

## Other

- **Enumeration date:** 06/26/2012
- **Last updated:** 06/26/2012