MD Orthotic and Prosthetic Laboratory, Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

060008643213000063 Issued in IL

Legal business name

MD ORTHOTIC AND PROSTHETIC LABORATORY, INC

Practice address

4801 W Peterson Ave
Ste 402
Chicago, IL 60646

Phone

(773) 545-6047

Fax

(888) 635-3135

NPI assigned

Jan 18, 2007

Last updated

Aug 5, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Donald Goertzen, CPO

Title

President

Phone

(309) 676-2276

Specialties & licenses 1

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Cpo Services, Inc

  dba Comprehensive Prosthetics & Orthotics

  • Prosthetic/Orthotic Supplier
  • Quincy, IL
  • NPI 1295062594

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1881746758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 W MAIN ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061953",
            "telephone_number": "800-334-5705",
            "fax_number": "888-663-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 W PETERSON AVE",
            "address_2": "STE 402",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60646",
            "telephone_number": "773-545-6047",
            "fax_number": "888-635-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD ORTHOTIC AND PROSTHETIC LABORATORY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "GOERTZEN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-676-2276",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IL",
            "license": "060008643213000063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• MD Developmental Agency LLC
• MD Developmental Agency LLC
• MD Family Medical Practice LLC
• MD Medical, LLC (Luxury Psychiatry and Medical Spa)
• MD Orthotic & Prosthetic Laboratory, Inc. (Comprehensive Prosthetics & Orthotics)
• MD2 Chicago
• Dana Mdanat
• MDC Consultant PLLC
• Mdhearingaid
• MDMC, LLC

• Prosthetic/Orthotic Supplier in Chicago, IL
• Providers in Chicago, IL by specialty
• Prosthetic/Orthotic Supplier in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.