Provider Demographics
NPI:1538383260
Name:WOODFIELD ORTHO SERVICES LLC
Entity type:Organization
Organization Name:WOODFIELD ORTHO SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:847-382-3222
Mailing Address - Street 1:37W002 MOOSEHEART RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60539-1022
Mailing Address - Country:US
Mailing Address - Phone:847-382-3222
Mailing Address - Fax:847-382-3223
Practice Address - Street 1:37W002 MOOSEHEART RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60539-1022
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:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCPO 1980222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid