Organization
NORTHERN ILLINOIS TRAUMA REGIONAL ORTHOPAEDICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW J BLINT MD (OWNER)
(815) 636-0700
Entity
Organization
Contact information
Practice address
1235 N MULFORD RD, SUITE 103, ROCKFORD, IL 61107-3879
(815) 636-0700
(815) 904-6033
Mailing address
1235 N MULFORD RD, SUITE 103, ROCKFORD, IL 61107-3879
(815) 636-0700
(815) 904-6033
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F100170041
—
IL
Enumeration date
07/24/2014
Last updated
03/27/2017
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