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General NPI Number Information
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NPI Number | 1700203510
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Entity Type | Organization
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Legal Business Name | DUPAGE PROSTHETIC-ORTHOTIC SERVICES
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 410 W ICE LAKE RD
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City | IRON RIVER
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State | MI
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Zip | 49935-8417
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Country | US
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Telephone | 630-261-9317
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Fax |
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Provider Business Mailing Address
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Address Line | 121 E ROOSEVELT RD SUITE B
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City | LOMBARD
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State | IL
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Zip | 60148-4561
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Country | US
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Telephone | 630-261-9317
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN ROONEY
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Credential | C.P.
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Telephone | 630-261-9317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 211.000188
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License Number State | IL
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