Organization
ORTHOMIDWEST, PLLC
Active
Other names
OrthoIllinois
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE ELMER CPCS (CREDENTIALING COORDINATOR)
(815) 381-7431
Entity
Organization
Contact information
Practice address
5875 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4937
(815) 398-9491
(815) 381-7333
Mailing address
PO BOX 735263, CHICAGO, IL 60673-5263
(815) 398-9491
(815) 381-7333
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
060010826
IL
Other
Enumeration date
08/20/2016
Last updated
04/19/2024
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