Provider Demographics
NPI:1962766865
Name:MIDAMERICA ORTHOPAEDICS, S.C.
Entity type:Organization
Organization Name:MIDAMERICA ORTHOPAEDICS, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAKHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-237-7200
Mailing Address - Street 1:1990 E ALGONQUIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4173
Mailing Address - Country:US
Mailing Address - Phone:847-303-5790
Mailing Address - Fax:847-303-5795
Practice Address - Street 1:1990 E ALGONQUIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4173
Practice Address - Country:US
Practice Address - Phone:847-303-5790
Practice Address - Fax:847-303-5795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076397207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty