Provider Demographics
NPI:1386258226
Name:ORTHO SPINE SURGICAL LLC
Entity type:Organization
Organization Name:ORTHO SPINE SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIRAJUDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-761-0500
Mailing Address - Street 1:1925 E 95TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4710
Mailing Address - Country:US
Mailing Address - Phone:773-761-0500
Mailing Address - Fax:773-761-1355
Practice Address - Street 1:1925 E 95TH ST STE 220
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4710
Practice Address - Country:US
Practice Address - Phone:773-761-0500
Practice Address - Fax:773-761-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center