Provider Demographics
NPI:1912908757
Name:ILLIANA ORTHOPEDICS INC
Entity type:Organization
Organization Name:ILLIANA ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SEIBT
Authorized Official - Suffix:
Authorized Official - Credentials:CP LPO
Authorized Official - Phone:708-532-5600
Mailing Address - Street 1:17222 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3368
Mailing Address - Country:US
Mailing Address - Phone:708-532-5600
Mailing Address - Fax:708-532-5611
Practice Address - Street 1:17222 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3368
Practice Address - Country:US
Practice Address - Phone:708-532-5600
Practice Address - Fax:708-532-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
IL222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid