Provider Demographics
NPI:1124283130
Name:GOLD COAST ORTHOPAEDIC AND SPINE SURGERY SC
Entity type:Organization
Organization Name:GOLD COAST ORTHOPAEDIC AND SPINE SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHOPAEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-907-6594
Mailing Address - Street 1:7200 N. WESTERN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645
Mailing Address - Country:US
Mailing Address - Phone:312-654-8800
Mailing Address - Fax:312-654-8801
Practice Address - Street 1:7200 N. WESTERN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645
Practice Address - Country:US
Practice Address - Phone:312-654-8800
Practice Address - Fax:312-654-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-20
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004364261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty