MEDICARE: AMERICAN LIMB & ORTHOPEDIC CO.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)		IN
2	335E00000X	Prosthetic/Orthotic Supplier		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396870325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN LIMB & ORTHOPEDIC CO.

Provider Business Mailing Address
First Line	:	2930 MCKINLEY AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2739
Country	:	US
Telephone Number	:	574-287-3767
Fax Number	:	574-289-0882

Provider Business Practice Location Address
First Line	:	4029 W. MAIN
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2763
Country	:	US
Telephone Number	:	269-381-8670
Fax Number	:	574-381-8672

Authorized Official
Title or Position	:	OFFICE MANAGER & DIRECTOR
Name	:	DAGMAR GUNDLER
Credential	:
Telephone Number	:	574-287-3767

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	01/19/2011

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