Healthcare Provider Details

I. General information

NPI: 1083661797
Provider Name (Legal Business Name): GEMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 W PETERSON AVE
CHICAGO IL
60659-4113
US

IV. Provider business mailing address

2434 W PETERSON AVE
CHICAGO IL
60659-4113
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-2445
  • Fax: 773-508-6699
Mailing address:
  • Phone: 773-878-2445
  • Fax: 773-508-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSEMARIE LAZARDE
Title or Position: OFFICE MANAGER
Credential:
Phone: 773-878-2445