Organization
MIDWEST ORTHOTIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM COSTELLO (DIR OF OPERATIONS)
(574) 233-3352
Entity
Organization
Contact information
Practice address
611 E DOUGLAS RD, MISHAWAKA, IN 46545-1464
(574) 204-2416
Mailing address
17530 DUGDALE DR, SOUTH BEND, IN 46635-1583
(574) 233-3352
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
12/05/2011
Last updated
12/05/2011
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