Organization
GENESIS ORTHOPEDICS & SPORTS MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HYTHEM P SHADID MD (OWNER)
(630) 377-1188
Entity
Organization
Contact information
Practice address
2900 FOXFIELD RD, SUITE 102, ST CHARLES, IL 60174-5799
(630) 377-1188
(630) 377-7360
Mailing address
2900 FOXFIELD RD, SUITE 102, ST CHARLES, IL 60174-5799
(630) 377-1188
(630) 377-7360
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036082388
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082388
—
IL
01
—
04525539
BCBS
IL
01
—
1205885001
LESNIEWSKI NPI
IL
01
—
1477567394
SHADID NPI
IL
01
—
DO4326
GROUP PTAN
IL
Enumeration date
02/06/2007
Last updated
11/17/2023
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