Organization
MD ORTHOTIC AND PROSTHETIC LABORATORIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD GOERTZEN CPO (PRESIDENT)
(309) 676-2276
Entity
Organization
Contact information
Practice address
9521 INDIANAPOLIS BLVD, SUITE B, HIGHLAND, IN 46322
(219) 736-8896
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200161960
—
IN
Enumeration date
05/20/2006
Last updated
07/30/2018
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