MEDICARE: KELLER ORTHOTICS 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1972650802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLER ORTHOTICS INC

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	:	MANAGER
Name	:	MRS. ROSE KELLER
Credential	:
Telephone Number	:	773-929-4700

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/14/2022

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Directions to “KELLER ORTHOTICS INC ” Practice Location

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