Provider Demographics
NPI:1790732329
Name:GEMA
Entity Type:Organization
Organization Name:GEMA
Other - Org Name:BALLERT ORTHOPEDIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-2445
Mailing Address - Street 1:1250 N MILL ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-6304
Mailing Address - Country:US
Mailing Address - Phone:630-637-9540
Mailing Address - Fax:630-637-9542
Practice Address - Street 1:1250 N MILL ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6304
Practice Address - Country:US
Practice Address - Phone:630-637-9540
Practice Address - Fax:630-637-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL=========003Medicaid