# BROADWAY ORTHOPEDICS LTD

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

## Provider details

- **NPI number:** 1952573149
- **Authorized official:** DR. ALFRED A AKKERON MD (PRESIDENT)
- **Authorized official phone:** (708) 344-0870

## Contact information

- **Practice address:** 1111 SUPERIOR ST, SUITE 305, MELROSE PARK, IL 60160-4138
- **Practice address phone:** (708) 344-0870
- **Practice address fax:** (708) 343-4490
- **Mailing address:** 1111SUPERIOR STREET, SUITE 305, MELROSE PARK, IL 60160-4158
- **Mailing address phone:** (708) 344-0870
- **Mailing address fax:** (708) 343-4490

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/27/2008
- **Last updated:** 05/01/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036042498 | — | IL |
| 01 | — | 1306880919 | PROVIDER NPI | — |
| 01 | — | 21604940 | BLUE CROSS BLUE SHIELD | — |