Organization
MIDWEST SPORTS MEDICINE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BENSON (ACCOUNT MANAGER)
(815) 267-8825
Entity
Organization
Contact information
Practice address
24600 W 127TH ST BLDG B SUITE 240, PLAINFIELD, IL 60585-9502
(815) 267-8825
(815) 267-8840
Mailing address
24600 W 127TH ST BLDG B SUITE 240, PLAINFIELD, IL 60585-9509
(815) 267-8825
(815) 267-8840
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-111005
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9932533
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/30/2007
Last updated
04/29/2026
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