Provider Demographics
NPI:1104691450
Name:KSMO ORTHOPEDICS LLC
Entity type:Organization
Organization Name:KSMO ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-819-2849
Mailing Address - Street 1:710 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5900
Mailing Address - Country:US
Mailing Address - Phone:312-819-2849
Mailing Address - Fax:312-981-1293
Practice Address - Street 1:4940 W 137TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66224-5940
Practice Address - Country:US
Practice Address - Phone:913-427-0060
Practice Address - Fax:913-372-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty