MD ORTHOTIC & PROSTHETIC LABORATORY, INC. (NPI# 1932652567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932652567 |
| Entity Type | Organization |
| Organization Name | MD ORTHOTIC & PROSTHETIC LABORATORY, INC. |
| Practice Address |
1514 E 87th St Lowr Level Chicago IL 60619 |
| Mailing Address |
741 W Main St Peoria IL 61606-1953 |
| Practice Telephone | 7737795896 |
| Practice Fax Number | 7737798869 |
| Mailing Telephone | 8003345705 |
| Mailing Fax Number | 8886636322 |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2018-07-30 |
| Authorized Official Name | 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 | 211000147 | IL | Suppliers |
| Street Address |
1514 E 87TH ST LOWR LEVEL |
| City | CHICAGO |
| State | IL |
| Zip Code | 60619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457985061 | Tonia Dorsey | Durable Medical Equipment & Medical Supplies | 951 E 80th Street, Apt 1, Chicago, IL 60619 | 2020-02-24 |
| 1821635509 | Lisa Strader | Technician | 8605 S. Dorchester, Chicago, IL 60619 | 2019-12-02 |
| 1821647579 | Deborah Joves | Technician | 8258 S. Woodlawn Ave, Chicago, IL 60619 | 2019-09-05 |
| 1194372458 | Cognitive Focus Centers, Inc. | Clinic/Center | 901 E 95th St, Chicago, IL 60619 | 2019-08-21 |
| 1588136360 | Zantraquilla Z Madkins | Transportation Broker | 7829 South Wabash, Chicago, IL 60619 | 2018-12-18 |
| 1619447497 | Bria Stanciel | Case Manager/Care Coordinator | 8419 S Cottage Grove, Chicago, IL 60619 | 2018-12-05 |
| 1184153520 | Jordane Kelley | Nurse's Aide | 7339 S Wabash Ave, Chicago, IL 60619 | 2017-06-08 |
| 1205362977 | Kristen Suing | Psychologist | 1111 E 87th St Ste 300, Chicago, IL 60619 | 2017-05-02 |
| 1720525280 | Senior Healthcare Services Inc | Physical Therapist | 9133 South Stoney Island, Chicago, IL 60619 | 2017-01-23 |
| 1649610593 | Zb Optical Inc. | Technician/Technologist | 7847 S Maryland Ave, Suite 100b, Chicago, IL 60619 | 2013-06-25 |
| Find all providers in zip 60619 | ||||
| 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 |
| 1245691211 | L A Jones Hair Restoration Center | Prosthetic/Orthotic Supplier | 1657 S. Troy, Chicago, IL 60623 | 2016-03-17 |
| 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.