Organization
ORTHOPEDICS OF ILLINOIS - THE BONE JOINT AND SPORTS MEDICINE CENTER S
Active
Other names
Ortho Illinois
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN STOUT (ADMINISTRATOR)
(309) 454-1616
Entity
Organization
Contact information
Practice address
2200 FORT JESSE RD STE 250, NORMAL, IL 61761-6290
(309) 454-1616
Mailing address
2200 FORT JESSE RD STE 250, NORMAL, IL 61761-6290
(309) 454-1616
(309) 454-5167
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036108279
IL
Other
Enumeration date
12/22/2010
Last updated
07/07/2011
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