| NPI | 1043678931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON BERGMANN President 847-729-7923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016.002683) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2017-02-06 |