Provider Demographics
NPI:1962202762
Name:RESTORATIVE ASSURANCE
Entity type:Organization
Organization Name:RESTORATIVE ASSURANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHETIC SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-329-9237
Mailing Address - Street 1:649 E GLENWOOD LANSING RD APT 1B
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1939
Mailing Address - Country:US
Mailing Address - Phone:773-329-9237
Mailing Address - Fax:
Practice Address - Street 1:14724 S LA GRANGE RD STE 17
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3227
Practice Address - Country:US
Practice Address - Phone:773-329-9237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier