Registry details
Type
Individual
Primary specialty
Orthopaedic Surgery, Sports Medicine
Enumerated
Jun 27, 2025
License(s)
125.087025 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1611 W HARRISON ST | Chicago, IL 60612-4861 | |
| LOCATION | 1611 W HARRISON ST | Chicago, IL 60612-4861 | 708-236-2778 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.