Organization
MCHENRY COUNTY ORTHOPAEDICS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MANETTE ANNE DECREMER (ADMINISTRATOR)
(815) 788-2018
Entity
Organization
Contact information
Practice address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3711
(815) 356-5200
(815) 356-5262
Mailing address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3711
(815) 356-5200
(815) 356-5262
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5619608
BLUE SHIELD GROUP NUMBER
IL
Enumeration date
09/05/2007
Last updated
12/12/2014
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