MEDICARE: FRANK RISKA B.O.C.O.O., L.O.

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	213.000183	IL

General Provider Information

NPI Number	:	1407397490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK RISKA B.O.C.O.O., L.O.

Provider Business Mailing Address
First Line	:	2451 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1509
Country	:	US
Telephone Number	:	773-929-4700
Fax Number	:	773-929-4725

Provider Business Practice Location Address
First Line	:	2451 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1509
Country	:	US
Telephone Number	:	773-929-4700
Fax Number	:	773-929-4725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	03/10/2017

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Directions to “ FRANK RISKA B.O.C.O.O., L.O.” Practice Location

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