Organization
INTEGRATED ORTHOPEDICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL WILFORD (OWNER)
(773) 744-1578
Entity
Organization
Contact information
Practice address
3717 N RAVENSWOOD AVE, SUITE 217, CHICAGO, IL 60613-3880
(773) 248-6400
Mailing address
3717 N RAVENSWOOD AVE, SUITE 217, CHICAGO, IL 60613-3880
(773) 248-6400
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203.000143
IL
332B00000X
Durable Medical Equipment & Medical Supplies
69000193A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632342
BLUE CROSS BLUE SHIELD
IL
05
—
200260850A
—
IN
Enumeration date
12/06/2006
Last updated
02/26/2013
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