MEDICARE: GOODHEALTH MEDICAL PRODUCTS, INC

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	203000439	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001633204	OTHER	IL	ILLINOIS BLUE CROSS BS

General Provider Information

NPI Number	:	1689761934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODHEALTH MEDICAL PRODUCTS, INC

Provider Business Mailing Address
First Line	:	2621 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1708
Country	:	US
Telephone Number	:	773-737-9005
Fax Number	:	773-737-9012

Provider Business Practice Location Address
First Line	:	2621 W 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1708
Country	:	US
Telephone Number	:	773-737-9005
Fax Number	:	773-737-9012

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAYCEE T EKUFU
Credential	:
Telephone Number	:	773-737-9005

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/06/2008

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Directions to “GOODHEALTH MEDICAL PRODUCTS, INC ” Practice Location

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