Provider Demographics
NPI:1144573353
Name:WOODFIELD ORTHO SERVICES, LLC
Entity Type:Organization
Organization Name:WOODFIELD ORTHO SERVICES, LLC
Other - Org Name:WOODFIELD ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
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 1:12380 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7655
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:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000121222Z00000X
IL211000166224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty