Orthopedic and Sports Enhancement Center, LLC
NPI #1003900820 in Bloomington, Illinois
Provider Information
- NPI Number
- 1003900820
- Entity Type
- Organization
- Organization Name
- Orthopedic and Sports Enhancement Center, LLC
- Primary Specialty
- Specialist
- Enumeration Date
- Oct 3, 2006
- Last Updated
- Sep 12, 2017
Practice Location
- Address
- 2406 E EMPIRE ST
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61704-3630
- Phone
- (309) 663-9300
Authorized Official
- Name
- J. ANTHONY DUSTMAN
- Title
- PRESIDENT
- Phone
- (309) 663-9300
Specialties & Taxonomy Codes
| Specialty |
|---|
| Orthopaedic Surgery |
| Specialist |
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