MD ORTHOTIC AND PROSTHETIC LABORATORY, INC (NPI# 1881746758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881746758 |
| Entity Type | Organization |
| Organization Name | MD ORTHOTIC AND PROSTHETIC LABORATORY, INC |
| Practice Address |
4801 W Peterson Ave Ste 402 Chicago IL 60646 |
| Mailing Address |
741 W Main St Peoria IL 61606-1953 |
| Practice Telephone | 7735456047 |
| Practice Fax Number | 8886353135 |
| Mailing Telephone | 8003345705 |
| Mailing Fax Number | 8886636322 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-05 |
| Authorized Official Name | MR. DONALD GOERTZEN (PRESIDENT) |
| Authorized Official Telephone | 3096762276 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | 0600086432130000 | IL | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043362932 | Md Orthotic and Prosthetic Laboratory, Inc | Prosthetic/Orthotic Supplier | 1614 W Central Rd, Suite 108, Arlington Heights, IL 60005 | 2007-01-18 |
| Street Address |
4801 W PETERSON AVE STE 402 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60646 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588667315 | Barry M Leavitt | Psychologist | 4801 W Peterson Ave, Ste 525, Chicago, IL 60646 | 2005-05-24 |
| 1790229441 | Valerie Deutsch | Behavioral Analyst | 4801 W Peterson Ave, Suite 512, Chicago, IL 60646-5713 | 2016-12-15 |
| 1730623729 | A Dragonfly Mind, LLC | Clinical Neuropsychologist | 4801 W Peterson Ave, Suite 301, Chicago, IL 60646-5726 | 2016-12-09 |
| 1760938260 | Catherine Bogacki | Social Worker | 4801 W Peterson Ave, Suite 308, Chicago, IL 60646-5713 | 2016-08-25 |
| 1841662434 | Paul Robert Muhr | Dentist | 4801 W Peterson Ave, Suite 407, Chicago, IL 60646-5713 | 2015-10-22 |
| 1548631245 | Amy Derusha | Behavioral Analyst | 4801 W Peterson Ave, 512, Chicago, IL 60646-5713 | 2015-10-07 |
| 1063818813 | Amalia Pepek | Nurse Practitioner | 4801 W Peterson Ave, Suite 506, Chicago, IL 60646-5713 | 2014-11-06 |
| 1689089286 | Roxanne Gayle | Behavioral Analyst | 4801 W Peterson Ave, #512, Chicago, IL 60646-5713 | 2014-06-23 |
| 1982018461 | Superior Rehab Center LLC | Physical Therapist | 4801 W Peterson Ave, 615, Chicago, IL 60646-5713 | 2014-06-12 |
| 1720415367 | Frank J Gutierrez | Counselor | 4801 W Peterson Ave, Suite 403, Chicago, IL 60646 | 2013-09-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801312087 | Manal Ibrahim | Dentist | 6228 N Keystone Ave, Chicago, IL 60646 | 2017-08-18 |
| 1750820742 | Kaitlin O'brien | Student in an Organized Health Care Education/Training Program | 5801 N Pulaski, Chicago, IL 60646 | 2017-02-23 |
| 1659810646 | Sofia Trani | Student in an Organized Health Care Education/Training Program | 5801 N. Pulaski Rd, Chicago, IL 60646 | 2017-02-23 |
| 1487191151 | Ronald E. Rysztogi | Naprapath | 5704 N. Austin, Chicago, IL 60646 | 2017-01-19 |
| 1417403148 | Joyful Dental Care | Clinic/Center | 6314 N. Cicero Avenue, Chicago, IL 60646 | 2016-09-01 |
| 1164889754 | Physicians At Call | Family Medicine | 5901 N. Cicero Ave, Ste 207, Chicago, IL 60646 | 2016-01-27 |
| 1245610617 | Arlett Payne | Physician Assistant | 5906 N Milwaukee, Chicago, IL 60646 | 2015-06-01 |
| 1811375843 | North River Mental Health Center | Community/Behavioral Health | 5801 North Pulaski Road, Chicago, IL 60646 | 2015-05-11 |
| 1003157298 | Family Choice Home Health | Homemaker | 5933 N Milwaukee Avenue, Chicago, IL 60646 | 2013-03-13 |
| 1235479593 | Antonina Skapars Trinkuns | Psychiatry & Neurology | 6404 N. Tahoma Ave., Chicago, IL 60646 | 2013-02-25 |
| Find all providers in zip 60646 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952909517 | Matayah Love | Prosthetic/Orthotic Supplier | 5833 W Madison St, Chicago, IL 60644-3840 | 2020-10-15 |
| 1710508239 | Vivian Danielle Williams | Prosthetic/Orthotic Supplier | 940 N Monticello Ave # 1, Chicago, IL 60651-3949 | 2020-05-06 |
| 1265053136 | Dfined Beauty LLC | Prosthetic/Orthotic Supplier | 1507 E 53rd St # 835, Chicago, IL 60615-4573 | 2020-05-02 |
| 1417515784 | Dionne Williams Group | Prosthetic/Orthotic Supplier | 6822 S Wood St, Chicago, IL 60636-3337 | 2019-06-03 |
| 1801358734 | Dionne Williams | Prosthetic/Orthotic Supplier | 1130 N Dearborn St Apt 2511, Chicago, IL 60610-2752 | 2019-04-01 |
| 1083174064 | Scheck & Siress Prosthetics, Inc | Prosthetic/Orthotic Supplier | 233 E Erie St Ste 200, Chicago, IL 60611-5938 | 2019-03-25 |
| 1366976243 | United Medical Market, Inc | Prosthetic/Orthotic Supplier | 1930 W Estes Ave, #104, Chicago, IL 60626-2363 | 2017-04-17 |
| 1124563218 | Ace Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 4315 N Lincoln Ave, Chicago, IL 60618-1711 | 2016-12-27 |
| 1174072276 | Eyepothecary | Prosthetic/Orthotic Supplier | 1726 W Chicago Ave, Chicago, IL 60622-5000 | 2016-09-30 |
| 1932652567 | Md Orthotic & Prosthetic Laboratory, Inc. | Prosthetic/Orthotic Supplier | 1514 E 87th St Lowr Level, Chicago, IL 60619 | 2016-08-01 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.