Healthcare Provider Details

I. General information

NPI: 1093130122
Provider Name (Legal Business Name): NILAN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 W NATIONAL AVE
ADDISON IL
60101-3130
US

IV. Provider business mailing address

1215 W NATIONAL AVE
ADDISON IL
60101-3130
US

V. Phone/Fax

Practice location:
  • Phone: 708-497-0831
  • Fax:
Mailing address:
  • Phone: 708-497-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TYLER A JEFFREY
Title or Position: MANAGER
Credential:
Phone: 708-497-0831