Healthcare Provider Details

I. General information

NPI: 1194780072
Provider Name (Legal Business Name): SCHECK & SIRESS PROSTHETICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 WAUKEGAN RD STE 400
LAKE BLUFF IL
60044-1634
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 847-444-0690
  • Fax: 847-444-0399
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number016624327
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number08-119
License Number StateIL

VIII. Authorized Official

Name: GRACE ANGELINE
Title or Position: REG COMPLIANCE SPECIALIST III
Credential:
Phone: 714-961-2102