Provider Demographics
NPI:1902943327
Name:WOODFIELD ORTHO SERVICES L.L.C.
Entity Type:Organization
Organization Name:WOODFIELD ORTHO SERVICES L.L.C.
Other - Org Name:WOODFIELD ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHOTIST PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-382-3222
Mailing Address - Street 1:20 EXECUTIVE CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9543
Mailing Address - Country:US
Mailing Address - Phone:847-382-3222
Mailing Address - Fax:847-382-3223
Practice Address - Street 1:20 EXECUTIVE CT
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9543
Practice Address - Country:US
Practice Address - Phone:847-382-3222
Practice Address - Fax:847-382-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCPO 1980332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-001Medicaid