Provider Demographics
NPI:1184667933
Name:ACCELERATED PROSTHETICS & ORTHOTICS INC
Entity Type:Organization
Organization Name:ACCELERATED PROSTHETICS & ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOURABH
Authorized Official - Middle Name:V
Authorized Official - Last Name:NAGALE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:847-296-7755
Mailing Address - Street 1:1480 RENAISSANCE DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-296-7755
Mailing Address - Fax:847-296-7722
Practice Address - Street 1:1480 RENAISSANCE DRIVE
Practice Address - Street 2:SUITE 306
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-296-7755
Practice Address - Fax:847-296-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL211000127335E00000X
IL213000186335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633525OtherBCBS
IL320071062001Medicaid
IL7693608OtherAETNA
IL01633525OtherBCBS