Healthcare Provider Details

I. General information

NPI: 1689801680
Provider Name (Legal Business Name): BRACEMAN P&O INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 W. CERMAK RD.
CHICAGO IL
60623
US

IV. Provider business mailing address

2830 W. CERMAK RD.
CHICAGO IL
60623-3512
US

V. Phone/Fax

Practice location:
  • Phone: 847-736-6686
  • Fax: 773-940-1943
Mailing address:
  • Phone: 847-736-6686
  • Fax: 773-940-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number211000181
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number213000103
License Number StateIL

VIII. Authorized Official

Name: MR. AMIR SHEIKH
Title or Position: C.P.O
Credential: PRACTITIONER
Phone: 847-736-6686