Organization
MD ORTHOTIC AND PROSTHETIC LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD GOERTZEN CPO (PRESIDENT)
(309) 676-2276
Entity
Organization
Contact information
Practice address
4801 W PETERSON AVE, STE 402, CHICAGO, IL 60646
(773) 545-6047
(888) 635-3135
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
08/05/2020
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