Provider Demographics
NPI:1194887166
Name:GOLD COAST ORTHOPEDICS AND REHABILITATION, LTD
Entity type:Organization
Organization Name:GOLD COAST ORTHOPEDICS AND REHABILITATION, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGENSTERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-719-3527
Mailing Address - Street 1:1443 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1505
Mailing Address - Country:US
Mailing Address - Phone:708-719-3527
Mailing Address - Fax:
Practice Address - Street 1:10140 191ST ST
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9381
Practice Address - Country:US
Practice Address - Phone:708-719-3527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052805207X00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750475349OtherNPI
IL01636549OtherBLUE SHIELD