Provider Demographics
NPI:1336893726
Name:ORTHOCARE CORP
Entity type:Organization
Organization Name:ORTHOCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-560-6151
Mailing Address - Street 1:17 W GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4844
Mailing Address - Country:US
Mailing Address - Phone:312-560-6151
Mailing Address - Fax:708-452-1444
Practice Address - Street 1:17 W GRAND AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4844
Practice Address - Country:US
Practice Address - Phone:312-560-6151
Practice Address - Fax:708-452-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty