Organization
ORTHOMIDWEST, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE ELMER CPCS (CREDENTIALING COORDINATOR)
(815) 381-7431
Entity
Organization
Contact information
Practice address
1073 W LANE RD, MACHESNEY PARK, IL 61115-1622
(815) 381-7431
(815) 381-7333
Mailing address
PO BOX 735263, CHICAGO, IL 60673-5263
(815) 381-7431
(815) 381-7333
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
060011100
IL
Other
Enumeration date
07/15/2016
Last updated
04/11/2025
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