Provider Demographics
NPI:1164426821
Name:DREHER ORTHOPEDIC INDUSTRIES, INC.
Entity Type:Organization
Organization Name:DREHER ORTHOPEDIC INDUSTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DREHER
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:708-848-4646
Mailing Address - Street 1:214 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2310
Mailing Address - Country:US
Mailing Address - Phone:708-848-4646
Mailing Address - Fax:708-848-1341
Practice Address - Street 1:214 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2310
Practice Address - Country:US
Practice Address - Phone:708-848-4646
Practice Address - Fax:708-848-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01670372OtherBCBS PROVIDER ID
IA0570184Medicaid
64126OtherAMERIGROUP INS
WI81297200Medicaid
56800OtherNORTHWOOD INS PROVIDER ID
MI854565584Medicaid
IN200088770AMedicaid
IL01670372OtherBCBS PROVIDER ID
64126OtherAMERIGROUP INS