Provider Demographics
NPI:1841247681
Name:GEMA
Entity type:Organization
Organization Name:GEMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:125 E LAKE COOK RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4356
Mailing Address - Country:US
Mailing Address - Phone:847-459-9006
Mailing Address - Fax:847-459-9182
Practice Address - Street 1:125 E LAKE COOK RD
Practice Address - Street 2:SUITE 221
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4356
Practice Address - Country:US
Practice Address - Phone:847-459-9006
Practice Address - Fax:847-459-9182
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
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========006Medicaid
IL=========006Medicaid