Provider Demographics
NPI:1215227996
Name:KELLER ORTHOTICS INC
Entity Type:Organization
Organization Name:KELLER ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-929-4700
Mailing Address - Street 1:2451 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1509
Mailing Address - Country:US
Mailing Address - Phone:773-929-4700
Mailing Address - Fax:773-929-4725
Practice Address - Street 1:524 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3306
Practice Address - Country:US
Practice Address - Phone:847-394-1182
Practice Address - Fax:847-394-1428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELLER ORTHOTICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0290650004Medicare NSC