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
DR. STEPHEN A BAKER M.D. (SECRETARY)
(630) 665-9155
Entity
Organization
Contact information
Practice address
1971 GOWDEY RD, SUITE 207, NAPERVILLE, IL 60563-4232
(630) 665-9155
(630) 665-9770
Mailing address
327 GUNDERSEN DR, SUITE A, CAROL STREAM, IL 60188-2402
(630) 665-9155
(630) 665-9770
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
042001705
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002215428
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
01
—
130944200
US DEPARTMENT OF LABOR
IL
Enumeration date
02/03/2017
Last updated
02/03/2017
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