Provider Demographics
NPI:1235254624
Name:GULBRANDSON ORTHOTICS, LTD
Entity Type:Organization
Organization Name:GULBRANDSON ORTHOTICS, LTD
Other - Org Name:GULBRANDSON O&P
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GULBRANDSON
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:847-639-4140
Mailing Address - Street 1:2615 3 OAKS RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6119
Mailing Address - Country:US
Mailing Address - Phone:847-639-4140
Mailing Address - Fax:847-639-4192
Practice Address - Street 1:2615 3 OAKS RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-6119
Practice Address - Country:US
Practice Address - Phone:847-639-4140
Practice Address - Fax:847-639-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========002Medicaid
IL=========002Medicaid