MEDICARE: MIDWEST MEDICAL SUPPLY & EQUIPMENT, 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		IL

General Provider Information

NPI Number	:	1912040221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST MEDICAL SUPPLY & EQUIPMENT, INC.

Provider Business Mailing Address
First Line	:	1152 S. MAYFIELD ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-5356
Country	:	US
Telephone Number	:	773-729-1102
Fax Number	:	708-449-7962

Provider Business Practice Location Address
First Line	:	1152 SOUTH MAYFIELD STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-5356
Country	:	US
Telephone Number	:	773-729-1102
Fax Number	:	708-449-7962

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALI M DAJANI
Credential	:
Telephone Number	:	773-729-1102

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/21/2022

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