Organization
MIDWEST ORTHOPAEDIC INSTITUTE P C
Active
Other names
Midwest Orthopaedic Institute SC
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ROSS (CREDENTIALING COORDINATOR)
(815) 991-2333
Entity
Organization
Contact information
Practice address
2111 MIDLANDS COURT, SYCAMORE, IL 60178
(815) 758-0000
(815) 758-0094
Mailing address
1952 ABERDEEN CT, SYCAMORE, IL 60178-3175
(815) 758-0000
(815) 748-3014
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
225100000X
Physical Therapist
—
—
261QM2500X
Medical Specialty Clinic/Center
060010536
IL
261QR0400X
Rehabilitation Clinic/Center
060010536
IL
332B00000X
Durable Medical Equipment & Medical Supplies
060010536
IL
332B00000X
Durable Medical Equipment & Medical Supplies
060010536
IN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041032
HEALTH ALLIANCE
IL
01
—
1915167
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
03/20/2006
Last updated
08/29/2018
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