Provider Demographics
NPI:1477500551
Name:AKM PEDORTHIC, INC.
Entity Type:Organization
Organization Name:AKM PEDORTHIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-697-2491
Mailing Address - Street 1:40W392 TRIPLE OAKS FARM DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-7427
Mailing Address - Country:US
Mailing Address - Phone:847-697-2491
Mailing Address - Fax:847-622-8048
Practice Address - Street 1:40W392 TRIPLE OAKS FARM DR
Practice Address - Street 2:SUITE B
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-7427
Practice Address - Country:US
Practice Address - Phone:847-697-2491
Practice Address - Fax:847-622-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532241OtherBLUE SHIELD
IL3711431911OtherTAX ID NUMBER
IL3711431911OtherTAX ID NUMBER
IL3711431911OtherTAX ID NUMBER