Organization
AKM PEDORTHIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUISE MOORE (ADMINISTRATOR)
(847) 697-2491
Entity
Organization
Contact information
Practice address
40W392 TRIPLE OAKS FARM DR, SUITE B, HAMPSHIRE, IL 60140-7427
(847) 697-2491
(847) 622-8048
Mailing address
40W392 TRIPLE OAKS FARM DR, SUITE B, HAMPSHIRE, IL 60140-7427
(847) 697-2491
(847) 622-8048
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04532241
BLUE SHIELD
IL
01
—
3711431911
TAX ID NUMBER
IL
Enumeration date
05/27/2006
Last updated
08/22/2020
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