Organization
MD ORTHOTIC AND PROSTHETIC LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRA F MICKELSON (MANAGER OF REVENUE CYCLE MANAGEMENT)
(309) 285-7752
Entity
Organization
Contact information
Practice address
387 SHUMAN BLVD STE 201E, NAPERVILLE, IL 60563-8306
(630) 283-1830
(630) 320-2282
Mailing address
741 W MAIN ST, PEORIA, IL 61606-1953
(309) 285-7752
(309) 285-7752
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/10/2023
Last updated
09/24/2024
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