Organization
THE PEDORTHIC SHOPPE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELANGELO SCAFIDI CERTIFIED PEDOTHIST (OWNER PRESIDENT)
(708) 453-4900
Entity
Organization
Contact information
Practice address
8344 W LAWRENCE AVE, NORRIDGE, IL 60706-3152
(708) 453-4900
(708) 453-3338
Mailing address
PO BOX 705, ITASCA, IL 60143-0705
(708) 453-4900
(708) 453-3338
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
332BC3200X
IL
Other
Enumeration date
01/11/2007
Last updated
08/22/2020
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