Organization
SWEDISHAMERICAN HOSPITAL
Active
Other names
Lundholm Orthopedics A Department of SwedishAmerican Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
DON DANIELS (VP)
(815) 966-2084
Entity
Organization
Contact information
Practice address
1340 CHARLES ST, SUITE 100, ROCKFORD, IL 61104
(779) 696-1900
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081
TRICARE SUFFIX #
IL
Enumeration date
06/07/2007
Last updated
07/12/2018
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