Organization
GEMA
Active
Other names
Ballert Orthopedic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLOS CARMONA (DIRECTOR)
(773) 878-2445
Entity
Organization
Contact information
Practice address
1200 N WESTMORELAND DR, SUITE 100, LAKE FOREST, IL 60045-1601
(773) 878-2445
(773) 508-6699
Mailing address
2434 W PETERSON AVE, CHICAGO, IL 60659-4113
(773) 878-2445
(773) 508-6699
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/23/2010
Last updated
01/26/2011
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