Healthcare Provider Details

I. General information

NPI: 1477500551
Provider Name (Legal Business Name): AKM PEDORTHIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40W392 TRIPLE OAKS FARM DR SUITE B
HAMPSHIRE IL
60140-7427
US

IV. Provider business mailing address

40W392 TRIPLE OAKS FARM DR SUITE B
HAMPSHIRE IL
60140-7427
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-2491
  • Fax: 847-622-8048
Mailing address:
  • Phone: 847-697-2491
  • Fax: 847-622-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LOUISE MOORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-697-2491