Healthcare Provider Details

I. General information

NPI: 1215939657
Provider Name (Legal Business Name): SUPERIOR ORTHOPEDICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 1207
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 1207
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-0386
  • Fax:
Mailing address:
  • Phone: 312-943-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY E SCHAEFER
Title or Position: PRESIDENT
Credential: CO
Phone: 312-943-0386