Healthcare Provider Details

I. General information

NPI: 1891699328
Provider Name (Legal Business Name): OFA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W 95TH ST STE 306
OAK LAWN IL
60453-2572
US

IV. Provider business mailing address

4700 W 95TH ST STE 306
OAK LAWN IL
60453-2572
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-3334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. STEVEN GELSOMINO
Title or Position: MANAGER
Credential: DPM
Phone: 708-424-3334