MEDICARE: SUPERIOR ORTHOPEDICS, INC.

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
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1215939657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR ORTHOPEDICS, INC.

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1207
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-943-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 1207
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-943-0386
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY E SCHAEFER
Credential	:	CO
Telephone Number	:	312-943-0386

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/11/2011

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