Healthcare Provider Details

I. General information

NPI: 1235730250
Provider Name (Legal Business Name): QUANTUM PROSTHETICS & ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 W 81ST ST STE 300
JUSTICE IL
60458-1350
US

IV. Provider business mailing address

440 N MCCLURG CT
CHICAGO IL
60611-4370
US

V. Phone/Fax

Practice location:
  • Phone: 312-300-4472
  • Fax: 312-300-4473
Mailing address:
  • Phone: 219-793-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VIKRAM CHOUDHARY
Title or Position: OWNER
Credential:
Phone: 312-300-4472