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General NPI Number Information
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NPI Number | 1144573353
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Entity Type | Organization
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Legal Business Name | WOODFIELD ORTHO SERVICES, LLC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 12380 PRINCETON DR
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City | HUNTLEY
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State | IL
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Zip | 60142-7655
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Country | US
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Telephone | 847-382-3222
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Fax | 847-382-3223
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Provider Business Mailing Address
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Address Line | 20 EXECUTIVE CT SUITE 2
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City | SOUTH BARRINGTON
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State | IL
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Zip | 60010-9543
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Country | US
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Telephone | 847-382-3222
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Fax | 847-382-3223
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRETT KRAMER
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Credential | C.P.O.
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Telephone | 847-382-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | 213000121
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 211000166
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License Number State | IL
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