Provider Demographics
NPI:1760439376
Name:GEMA, INC
Entity Type:Organization
Organization Name:GEMA, INC
Other - Org Name:BALLERT ORTHOPEDIC OF CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-2445
Mailing Address - Street 1:2434 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4113
Mailing Address - Country:US
Mailing Address - Phone:773-878-2445
Mailing Address - Fax:773-469-8237
Practice Address - Street 1:1525 E 53RD ST STE 716
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4530
Practice Address - Country:US
Practice Address - Phone:773-493-2445
Practice Address - Fax:773-769-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid