Organization
ORTHOMIDWEST, PLLC
Active
Other names
OrthoIllinois
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE ELMER CPCS (MANAGER, CREDENTIALING AND RISK MAN)
(815) 381-7431
Entity
Organization
Contact information
Practice address
4119 W SHAMROCK LN, MCHENRY, IL 60050-8268
(815) 398-9491
Mailing address
5875 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4937
(815) 381-7431
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/25/2020
Last updated
01/20/2023
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