Provider Demographics
NPI:1609922715
Name:ACME ORTHOTIC & PROSTHETIC LABS, INC.
Entity Type:Organization
Organization Name:ACME ORTHOTIC & PROSTHETIC LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:773-363-0400
Mailing Address - Street 1:1840 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2019
Mailing Address - Country:US
Mailing Address - Phone:773-363-0400
Mailing Address - Fax:773-363-5462
Practice Address - Street 1:1840 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2019
Practice Address - Country:US
Practice Address - Phone:773-363-0400
Practice Address - Fax:773-363-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0221450001Medicare ID - Type Unspecified