Organization
WHEATON ORTHOPAEDICS, LTD.
Active
Parent organization
WHEATON ORTHOPAEDICS, LTD
Other names
SportsMed Wheaton Orthopaedics
Organization subpart
Yes
Provider details
NPI number
Legal business name
WHEATON ORTHOPAEDICS, LTD
Authorized official
MRS. MAMIE T MARTIN (BUSINESS OFFICE MANAGER)
(630) 784-3295
Entity
Organization
Contact information
Practice address
327 GUNDERSEN DR, SUITE A, CAROL STREAM, IL 60188-2402
(630) 665-9155
(630) 665-5557
Mailing address
327 GUNDERSEN DR, SUITE A, CAROL STREAM, IL 60188-2402
(630) 665-9155
(630) 665-5557
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041162131
IL
163W00000X
Registered Nurse
041261134
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02233497
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
Enumeration date
11/25/2008
Last updated
11/25/2008
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