Provider Demographics
NPI:1740466101
Name:DUPAGE PROSTHETIC - ORTHOTIC
Entity type:Organization
Organization Name:DUPAGE PROSTHETIC - ORTHOTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP CPED
Authorized Official - Phone:630-261-9317
Mailing Address - Street 1:121 E ROOSEVELT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4561
Mailing Address - Country:US
Mailing Address - Phone:630-261-9317
Mailing Address - Fax:630-261-9319
Practice Address - Street 1:121 E ROOSEVELT RD
Practice Address - Street 2:SUITE B
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4561
Practice Address - Country:US
Practice Address - Phone:630-261-9317
Practice Address - Fax:630-261-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X, 332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4486340001Medicare NSC