MEDICARE: ACME ORTHOTIC & PROSTHETIC LABS, 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		IL

General Provider Information

NPI Number	:	1609922715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACME ORTHOTIC & PROSTHETIC LABS, INC.

Provider Business Mailing Address
First Line	:	1840 E 71ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2019
Country	:	US
Telephone Number	:	773-363-0400
Fax Number	:	773-363-5462

Provider Business Practice Location Address
First Line	:	1840 E 71ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2019
Country	:	US
Telephone Number	:	773-363-0400
Fax Number	:	773-363-5462

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL A LEWIS
Credential	:	CPO
Telephone Number	:	773-363-0400

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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