Provider Demographics
NPI:1487120051
Name:ORCHARD REHABILITATION MEDICINE PLLC
Entity type:Organization
Organization Name:ORCHARD REHABILITATION MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TOMASZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PODOBINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-360-0970
Mailing Address - Street 1:675 GROVE DR APT 114
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:365 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-2628
Practice Address - Country:US
Practice Address - Phone:224-360-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty