Provider Demographics
NPI:1053360818
Name:BUFFALO GROVE ORTHOPAEDIC ASSOCIATES SC
Entity type:Organization
Organization Name:BUFFALO GROVE ORTHOPAEDIC ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:STAMELOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-520-8900
Mailing Address - Street 1:600 W LAKE COOK RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2091
Mailing Address - Country:US
Mailing Address - Phone:847-520-8900
Mailing Address - Fax:847-520-9190
Practice Address - Street 1:600 W LAKE COOK RD
Practice Address - Street 2:SUITE 160
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2091
Practice Address - Country:US
Practice Address - Phone:847-520-8900
Practice Address - Fax:847-520-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619562OtherBLUE CROSS BLUE SHIELD
C31320OtherMEDICARE RAILROAD
C31320OtherMEDICARE RAILROAD
IL0721670001Medicare NSC