Organization
GOLD COAST ORTHOPEDICS AND REHABILITATION, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB MORGENSTERN M.D. (OWNER)
(708) 719-3527
Entity
Organization
Contact information
Practice address
10140 191ST ST, MOKENA, IL 60448-9381
(708) 719-3527
Mailing address
1443 N DEARBORN ST, CHICAGO, IL 60610-1505
(708) 719-3527
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036052805
IL
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636549
BLUE SHIELD
IL
01
—
1750475349
NPI
—
Enumeration date
12/15/2006
Last updated
02/09/2024
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