Organization
MD ORTHOTIC AND PROSTHETIC LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD GOERTZEN (PRESIDENT)
(309) 676-2276
Entity
Organization
Contact information
Practice address
227 N HAMMES AVE, JOLIET, IL 60435
(708) 387-9700
(708) 387-9704
Mailing address
8400 BROOKFIELD AVE, 1ST FLOOR, BROOKFIELD, IL 60513-1707
(708) 387-9700
(708) 387-9704
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
060008643213000063
IL
Other
Enumeration date
01/18/2007
Last updated
07/30/2018
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