MEDICARE: WOODLAKE TECHNOLOGIES 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	28913027	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992857833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAKE TECHNOLOGIES INC

Provider Business Mailing Address
First Line	:	666 W. HUBBARD ST.
Second Line	:	SUITE 3
City	:	CHICAGO
State	:	IL
Zip	:	60654-5509
Country	:	US
Telephone Number	:	312-733-9800
Fax Number	:	312-243-9284

Provider Business Practice Location Address
First Line	:	666 W. HUBBARD ST
Second Line	:	SUITE 3
City	:	CHICAGO
State	:	IL
Zip	:	60654-5509
Country	:	US
Telephone Number	:	312-733-9800
Fax Number	:	312-243-9284

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RALPH SAMEK
Credential	:
Telephone Number	:	312-733-9800

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/16/2015

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