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Organization

MD ORTHOTIC & PROSTHETIC LABORATORY, INC.

Active
Other names
Comprehensive Prosthetics & Orthotics
Organization subpart
No

Provider details

NPI number
Authorized official
KENDRA F MICKELSON (MANAGER OF REVENUE CYCLE MANAGEMENT)
(309) 285-7752
Entity
Organization

Contact information

Practice address
8741 S GREENWOOD AVE STE 101, CHICAGO, IL 60619-7058
(773) 779-5869
(773) 779-8869
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
211000147
IL

Other

Enumeration date
08/01/2016
Last updated
09/02/2025
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