Organization
CHICAGO SPORTS MEDICINE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN MATTHEWS (BILLING MANAGER)
(773) 480-4584
Entity
Organization
Contact information
Practice address
875 N DEARBORN ST, CHICAGO, IL 60610-7377
(312) 255-7540
(312) 255-1276
Mailing address
875 N DEARBORN ST, CHICAGO, IL 60610-7377
(312) 255-7540
(312) 255-1276
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036091945
LICENSE
IL
Enumeration date
08/04/2017
Last updated
07/22/2024
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