Organization
ORTHOPEDIC & SPORTS MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN STOUT (CHIEF OPERATING OFFICER)
(309) 454-1616
Entity
Organization
Contact information
Practice address
2200 FORT JESSE RD STE 250, NORMAL, IL 61761-6290
(309) 454-1616
Mailing address
PO BOX 1645, BLOOMINGTON, IL 61702-1645
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
042-616684
IL
Other
Enumeration date
08/28/2006
Last updated
03/23/2011
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