Organization
MD ORTHOTIC AND PROSTHETIC LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMIT BHANTI CPO (CEO)
(309) 676-2276
Entity
Organization
Contact information
Practice address
3077 W JEFFERSON ST STE 101, JOLIET, IL 60435-5263
(779) 545-2270
(779) 601-0195
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
Other
Enumeration date
01/18/2007
Last updated
06/26/2025
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