Organization
MD ORTHOTIC AND PROSTHETIC LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMIT BHANIT CPO (CEO)
(309) 676-2276
Entity
Organization
Contact information
Practice address
4710 W 95TH ST STE B4, OAK LAWN, IL 60453
(773) 779-5896
(773) 779-8869
Mailing address
741 W MAIN ST, PEORIA, IL 61606-1953
(800) 334-5705
(888) 663-6322
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
060008643213000063
IL
335E00000X
Prosthetic/Orthotic Supplier
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Other
Enumeration date
01/17/2007
Last updated
09/24/2024
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