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General NPI Number Information
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NPI Number | 1780198887
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Entity Type | Organization
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Legal Business Name | MIOMED ORTHOPAEDICS, INC.
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 2502 N CLARK ST STE 207
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City | CHICAGO
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State | IL
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Zip | 60614-1850
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Country | US
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Telephone | 773-477-8991
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Fax | 773-477-4001
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Provider Business Mailing Address
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Address Line | 2506 N CLARK ST STE 290
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City | CHICAGO
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State | IL
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Zip | 60614-1848
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Country | US
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Telephone | 773-477-8991
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Fax | 773-477-4001
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK ALEXANDER SORENSEN
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Credential |
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Telephone | 773-477-8991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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