Healthcare Provider Details

I. General information

NPI: 1528239605
Provider Name (Legal Business Name): PERFECT FIT FOOTWEAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15618 S 70TH CT
ORLAND PARK IL
60462-5108
US

IV. Provider business mailing address

15618 S 70TH CT
ORLAND PARK IL
60462-5108
US

V. Phone/Fax

Practice location:
  • Phone: 708-532-3302
  • Fax: 708-532-3312
Mailing address:
  • Phone: 708-532-3302
  • Fax: 708-532-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number212000132
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number212000132
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number212000132
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number212000132
License Number StateIL

VIII. Authorized Official

Name: EDGAR ALEXANDER BARRIOS
Title or Position: OWNER
Credential: CPED
Phone: 312-479-0403