Healthcare Provider Details

I. General information

NPI: 1720547243
Provider Name (Legal Business Name): PRO MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 01/21/2023
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12337 S ROUTE 59 UNIT 119
PLAINFIELD IL
60585-4626
US

IV. Provider business mailing address

12337 S ROUTE 59 UNIT 119
PLAINFIELD IL
60585-4626
US

V. Phone/Fax

Practice location:
  • Phone: 815-267-6263
  • Fax: 815-782-8549
Mailing address:
  • Phone: 815-267-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RANDAL CYBULSKI
Title or Position: OWNER
Credential: DC, CCSP
Phone: 815-267-6263