Organization
WAXBERG ORTHOPEDIC SHOES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD WAXBERG (OWNER)
(847) 965-3338
Entity
Organization
Contact information
Practice address
7013 W DEMPSTER ST, NILES, IL 60714-2130
(847) 965-3338
(847) 965-3337
Mailing address
7013 W DEMPSTER ST, NILES, IL 60714-2130
(847) 965-3338
(847) 965-3337
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000297127
BCBS ANTHEM OF OHIO
OH
01
—
0001670958
BCBS OF IL
IL
Enumeration date
08/12/2006
Last updated
06/14/2010
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