Healthcare Provider Details

I. General information

NPI: 1992174064
Provider Name (Legal Business Name): CHICAGO AMPUTEE CLINIC PROSTHETICS &ORTHOTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8419 S COTTAGE GROVE AVE
CHICAGO IL
60619
US

IV. Provider business mailing address

8419 S COTTAGE GROVE AVE
CHICAGO IL
60619-6113
US

V. Phone/Fax

Practice location:
  • Phone: 847-736-6686
  • Fax:
Mailing address:
  • Phone: 847-736-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. AMIR SHEIKH
Title or Position: PRESIDENT
Credential:
Phone: 847-736-6686