Provider Demographics
NPI:1235730250
Name:QUANTUM PROSTHETICS & ORTHOTICS LLC
Entity Type:Organization
Organization Name:QUANTUM PROSTHETICS & ORTHOTICS LLC
Other - Org Name:QUANTUM PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-300-4472
Mailing Address - Street 1:440 N MCCLURG CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4370
Mailing Address - Country:US
Mailing Address - Phone:219-793-3339
Mailing Address - Fax:
Practice Address - Street 1:9050 W 81ST ST STE 300
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-1350
Practice Address - Country:US
Practice Address - Phone:312-300-4472
Practice Address - Fax:312-300-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies