MEDICARE: WINDHAM MEDICAL SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RFP797FSS990025R4	OTHER		VA NATIONAL ACQUICITION C

General Provider Information

NPI Number	:	1407920473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDHAM MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	2056 EAST 71ST STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2117
Country	:	US
Telephone Number	:	773-288-2844
Fax Number	:	773-288-2848

Provider Business Practice Location Address
First Line	:	2056 EAST 71ST STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2117
Country	:	US
Telephone Number	:	773-288-2844
Fax Number	:	773-288-2848

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MATT WINDHAM JR.
Credential	:
Telephone Number	:	773-288-2844

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	03/28/2008

Similar Medicare Providers

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Practice Location Address:

2056 E 71ST ST
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Practice Location Address:

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1679580930 — DR. MURRY ALAN BASS MD
Practice Location Address:

4085 N BROADWAY ST
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1225121262 — MISS CLAY DEBRA CHALUPA LCPC
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1861610842 — DR. MOHAMMAD H TAHERI DMD
Practice Location Address:

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Practice Fax:

Directions to “WINDHAM MEDICAL SUPPLIES ” Practice Location

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