MEDICARE: ACE PROSTHETICS & ORTHOTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1124563218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE PROSTHETICS & ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	440 N MCCLURG CT
Second Line	:	APT 113
City	:	CHICAGO
State	:	IL
Zip	:	60611-4370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1711
Country	:	US
Telephone Number	:	219-793-3339
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIKRAM CHOUDHARY
Credential	:
Telephone Number	:	219-793-3339

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	12/27/2016

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