Provider Demographics
NPI:1548437551
Name:GREENLEAF ORTHOPAEDIC ASSOCIATES S C
Entity type:Organization
Organization Name:GREENLEAF ORTHOPAEDIC ASSOCIATES S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-623-3090
Mailing Address - Street 1:105 N GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3326
Mailing Address - Country:US
Mailing Address - Phone:847-623-3090
Mailing Address - Fax:847-623-9620
Practice Address - Street 1:2552 N ROUTE 83
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073
Practice Address - Country:US
Practice Address - Phone:224-444-2050
Practice Address - Fax:224-444-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0515420001Medicare NSC
IL597240Medicare PIN